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General NPI Number Information
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NPI Number | 1982364253
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Entity Type | Individual
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Provider Name | KAYLA NICOLE LEGGETT PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 1906 BELLEVIEW AVE SE
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City | ROANOKE
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State | VA
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Zip | 24014-1838
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Country | US
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Telephone | 540-206-8736
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Fax |
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Provider Business Mailing Address
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Address Line | 10215 LOVING TRAIL DR
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City | FRISCO
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State | TX
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Zip | 75035-8177
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Country | US
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Telephone | 214-504-4309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15387
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License Number State | TX
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