MEDICARE: MICHELLE THEIS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3006566	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50034884	OTHER	KY	PASSPORT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942518998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE THEIS APRN

Provider Business Mailing Address
First Line	:	11701 BLUEGRASS PKWY STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2302
Country	:	US
Telephone Number	:	502-245-4168
Fax Number	:	502-244-0454

Provider Business Practice Location Address
First Line	:	11701 BLUEGRASS PKWY STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2302
Country	:	US
Telephone Number	:	502-245-4168
Fax Number	:	502-244-0454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	02/23/2024

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Directions to “ MICHELLE THEIS APRN” Practice Location

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