Provider Demographics
NPI:1861660706
Name:LEGG, BETSY DAWN (FNP-MSN)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:DAWN
Last Name:LEGG
Suffix:
Gender:F
Credentials:FNP-MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1304
Mailing Address - Country:US
Mailing Address - Phone:304-755-0119
Mailing Address - Fax:304-755-0111
Practice Address - Street 1:4114 1ST AVE
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1304
Practice Address - Country:US
Practice Address - Phone:304-755-0119
Practice Address - Fax:304-755-0111
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN56058363LF0000X
WV56058163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005642Medicaid