Provider Demographics
NPI:1033685748
Name:LEGGETT, CODI DANIELLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CODI
Middle Name:DANIELLE
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2821
Mailing Address - Country:US
Mailing Address - Phone:936-441-9680
Mailing Address - Fax:936-539-9680
Practice Address - Street 1:100 MEDICAL CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2821
Practice Address - Country:US
Practice Address - Phone:936-441-9680
Practice Address - Fax:936-539-9685
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily