Provider Demographics
NPI:1659983575
Name:LEGER, JETTIE D (APRN)
Entity Type:Individual
Prefix:
First Name:JETTIE
Middle Name:D
Last Name:LEGER
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 1:2090 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6702
Mailing Address - Country:US
Mailing Address - Phone:785-825-8221
Mailing Address - Fax:785-452-7530
Practice Address - Street 1:2090 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6702
Practice Address - Country:US
Practice Address - Phone:785-825-8221
Practice Address - Fax:785-452-7530
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79631-101363LF0000X
KS53-79631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004725230001Medicaid