Healthcare Provider Details

I. General information

NPI: 1588091706
Provider Name (Legal Business Name): KELLY LYNN LEGG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY L TAYLOR FNP-BC

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 COMMERCE DR
BEAVER WV
25813-8985
US

IV. Provider business mailing address

354 COMMERCE DR
BEAVER WV
25813-8985
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-0150
  • Fax:
Mailing address:
  • Phone: 304-250-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71128
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: