Provider Demographics
NPI:1639667363
Name:LEGG, HOLLY A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:A
Last Name:LEGG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7221
Mailing Address - Country:US
Mailing Address - Phone:620-371-7300
Mailing Address - Fax:620-371-7304
Practice Address - Street 1:200 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7221
Practice Address - Country:US
Practice Address - Phone:620-371-7300
Practice Address - Fax:620-371-7304
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78182-042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily