Healthcare Provider Details

I. General information

NPI: 1003462557
Provider Name (Legal Business Name): STEPHANIE LYNN LEGG APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 CHESTERFIELD AVE STE 302
CHARLESTON WV
25304-1064
US

IV. Provider business mailing address

2345 CHESTERFIELD AVE STE 302
CHARLESTON WV
25304-1064
US

V. Phone/Fax

Practice location:
  • Phone: 681-205-8610
  • Fax: 681-205-8615
Mailing address:
  • Phone: 681-205-8610
  • Fax: 681-205-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104224
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: