Provider Demographics
NPI:1588091706
Name:LEGG, KELLY LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:LEGG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:354 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-8985
Mailing Address - Country:US
Mailing Address - Phone:304-250-0150
Mailing Address - Fax:
Practice Address - Street 1:354 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8985
Practice Address - Country:US
Practice Address - Phone:304-250-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV71128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily