Provider Demographics
NPI:1215503875
Name:LETCHWORTH, HAYLEY JANE (PA)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:JANE
Last Name:LETCHWORTH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:JANE
Other - Last Name:HANSFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:451 NW MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1425
Mailing Address - Country:US
Mailing Address - Phone:816-524-1007
Mailing Address - Fax:816-524-1988
Practice Address - Street 1:451 NW MURRAY RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1425
Practice Address - Country:US
Practice Address - Phone:816-524-1007
Practice Address - Fax:816-524-1988
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS363A00000X
MO2021047799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant