Provider Demographics
NPI:1376067835
Name:LEGGETT, TAYLER RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:RENEE
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLER
Other - Middle Name:RENEE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:280 HIGHWAY 418 E
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-3729
Mailing Address - Country:US
Mailing Address - Phone:409-386-1200
Mailing Address - Fax:
Practice Address - Street 1:280 HIGHWAY 418 E
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3729
Practice Address - Country:US
Practice Address - Phone:409-386-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11309363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty