Provider Demographics
NPI:1174330732
Name:LEGG, ALEXANDRIA GRACE (CRNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:GRACE
Last Name:LEGG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:GRACE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:122 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1221
Mailing Address - Country:US
Mailing Address - Phone:256-410-3544
Mailing Address - Fax:
Practice Address - Street 1:122 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1221
Practice Address - Country:US
Practice Address - Phone:256-410-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-185023163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice