Provider Demographics
NPI:1396316444
Name:LETCHER, CONNOR (PNP-C)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:LETCHER
Suffix:
Gender:M
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-5050
Mailing Address - Country:US
Mailing Address - Phone:315-598-6785
Mailing Address - Fax:
Practice Address - Street 1:909 W 1ST ST S
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-5050
Practice Address - Country:US
Practice Address - Phone:315-598-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383246-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics