Provider Demographics
NPI:1023901436
Name:THEISS, LORA J (LPN)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:J
Last Name:THEISS
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 1:5506 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40068-1401
Mailing Address - Country:US
Mailing Address - Phone:502-232-1982
Mailing Address - Fax:
Practice Address - Street 1:5506 MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:KY
Practice Address - Zip Code:40068-1401
Practice Address - Country:US
Practice Address - Phone:502-232-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2036502164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse