Provider Demographics
NPI:1184267916
Name:LEGAN, ASHLEY NICOLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:LEGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4351 BOOTH CALLOWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7319
Mailing Address - Country:US
Mailing Address - Phone:713-775-8771
Mailing Address - Fax:
Practice Address - Street 1:4351 BOOTH CALLOWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7319
Practice Address - Country:US
Practice Address - Phone:817-214-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13101363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant