Provider Demographics
NPI:1376856278
Name:LEGACY, VALERIE LYNNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNNE
Last Name:LEGACY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:KAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1715
Mailing Address - Country:US
Mailing Address - Phone:317-924-6351
Mailing Address - Fax:317-927-3098
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-880-0000
Practice Address - Fax:317-880-0565
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28098488163W00000X, 163WG0100X
IN71003295A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28098488OtherREGISTERED NURSE