Healthcare Provider Details

I. General information

NPI: 1508579988
Provider Name (Legal Business Name): LEGENDARY MEDICAL STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 BARBEE LN STE 104B
KNOXVILLE TN
37923-6256
US

IV. Provider business mailing address

9080 BARBEE LN STE 104B
KNOXVILLE TN
37923-6256
US

V. Phone/Fax

Practice location:
  • Phone: 865-226-9679
  • Fax: 865-273-0266
Mailing address:
  • Phone: 865-226-9679
  • Fax: 865-273-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER WHITE
Title or Position: CEO
Credential: RN
Phone: 865-226-9679