Healthcare Provider Details

I. General information

NPI: 1043144827
Provider Name (Legal Business Name): HAYLEY ROSE RUPP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4200
  • Fax:
Mailing address:
  • Phone: 513-636-3874
  • Fax: 513-636-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010598RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: