Healthcare Provider Details

I. General information

NPI: 1710715560
Provider Name (Legal Business Name): DYLAN LEGGETT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

16460 VILLA BRIELLE AVE
BATON ROUGE LA
70817-2500
US

V. Phone/Fax

Practice location:
  • Phone: 318-769-3000
  • Fax:
Mailing address:
  • Phone: 225-274-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN148877
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: