Provider Demographics
NPI:1295596096
Name:LEGACY DEVELOPMENTAL PEDIATRICS, PLLC
Entity type:Organization
Organization Name:LEGACY DEVELOPMENTAL PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:806-300-8228
Mailing Address - Street 1:2505 79TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2211
Mailing Address - Country:US
Mailing Address - Phone:806-300-8228
Mailing Address - Fax:806-300-8223
Practice Address - Street 1:2505 79TH ST STE B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2211
Practice Address - Country:US
Practice Address - Phone:806-300-8228
Practice Address - Fax:806-300-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty