Provider Demographics
NPI:1487824140
Name:KELLEY, LORA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:JEAN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 COUNTY ROAD 119
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8116
Mailing Address - Country:US
Mailing Address - Phone:740-533-3744
Mailing Address - Fax:
Practice Address - Street 1:1027 COUNTY ROAD 119
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-8116
Practice Address - Country:US
Practice Address - Phone:740-533-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 128787164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse