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General NPI Number Information
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NPI Number | 1194440503
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Entity Type | Organization
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Legal Business Name | LETT MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 6960 FOREST HILL AVE STE B
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City | RICHMOND
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State | VA
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Zip | 23225-1606
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Country | US
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Telephone | 804-219-9519
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Fax | 804-293-3934
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Provider Business Mailing Address
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Address Line | 1707 WINESAP DR
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City | RICHMOND
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State | VA
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Zip | 23231-5147
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Country | US
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Telephone | 804-219-9519
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Fax | 804-293-3934
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Authorized Official
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Title or Position | OWNER
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Name | DEXTER S LETT
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Credential | PMHNP-BC
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Telephone | 804-219-9519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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