Healthcare Provider Details

I. General information

NPI: 1154720464
Provider Name (Legal Business Name): KURT S CONNER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COMMERCIAL ST
LEAVENWORTH WA
98826-1316
US

IV. Provider business mailing address

16930 CHUMSTICK HWY
LEAVENWORTH WA
98826-9579
US

V. Phone/Fax

Practice location:
  • Phone: 509-548-5815
  • Fax: 509-548-2510
Mailing address:
  • Phone: 541-600-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: