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General NPI Number Information
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NPI Number | 1467322776
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Entity Type | Individual
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Provider Name | CONNER DANIEL THURTELL PA
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Gender | Male
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 10039 UNIVERSITY CITY BLVD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28213-3699
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Country | US
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Telephone | 704-625-2594
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Fax |
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Provider Business Mailing Address
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Address Line | 5003 OAK CT
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City | LONG BEACH
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State | MS
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Zip | 39560-3707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-16215
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License Number State | NC
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