Provider Demographics
NPI:1184113367
Name:LEGARDYE, CLARISSA GAY
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:GAY
Last Name:LEGARDYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E ARAPAHO RD APT 2201
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3188
Mailing Address - Country:US
Mailing Address - Phone:972-839-3620
Mailing Address - Fax:
Practice Address - Street 1:2000 E ARAPAHO RD APT 2201
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3188
Practice Address - Country:US
Practice Address - Phone:972-839-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX835208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse