Provider Demographics
NPI:1184133365
Name:LEGLER, KETURAH (CPNP)
Entity type:Individual
Prefix:
First Name:KETURAH
Middle Name:
Last Name:LEGLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KETURAH
Other - Middle Name:LEE
Other - Last Name:LEGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:9827 N 95TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4591
Mailing Address - Country:US
Mailing Address - Phone:650-721-5400
Mailing Address - Fax:
Practice Address - Street 1:9827 N 95TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4591
Practice Address - Country:US
Practice Address - Phone:650-721-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005555363L00000X
CANP95005555363LP0200X
AZ306601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics