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General NPI Number Information
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NPI Number | 1811411838
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Entity Type | Organization
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Legal Business Name | LEGENDARY FAMILY HEALTHCARE PLLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5372 N LONG RIFLE RD
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-4215
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Country | US
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Telephone | 623-666-3743
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Fax |
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Provider Business Mailing Address
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Address Line | 5372 N LONG RIFLE RD
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-4215
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Country | US
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Telephone | 623-666-3743
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Fax | 928-227-4110
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TIMOTHY LEE MCGHEE
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Credential | MSN
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Telephone | 623-666-3743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP10407
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License Number State | AZ
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