Healthcare Provider Details

I. General information

NPI: 1427902154
Provider Name (Legal Business Name): LYNDEL MAE THEIS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COMMODORE ST
PRATT KS
67124-2903
US

IV. Provider business mailing address

518 LARIMER ST
PRATT KS
67124-1315
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7451
  • Fax: 620-450-1741
Mailing address:
  • Phone: 620-672-7451
  • Fax: 620-450-1741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85300-112
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: