Provider Demographics
NPI:1740908383
Name:LEGGETT, BOBBI TAYLOR (LPN)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:TAYLOR
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEBB
Mailing Address - State:AL
Mailing Address - Zip Code:36376-7210
Mailing Address - Country:US
Mailing Address - Phone:334-699-0034
Mailing Address - Fax:
Practice Address - Street 1:256 HONEYSUCKLE RD STE 12
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1168
Practice Address - Country:US
Practice Address - Phone:334-792-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-067913164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse