Active NPI
Legacy Wellness
- Family Medicine Physician
- Lawton, OK
National Provider Identifier
1033989272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- LEGACY WELLNESS
- Doing business as
- LEGACY WELLNESS CENTER
- Practice address
- 927 SW D Ave
Lawton, OK 73501-4530 - Phone
- (405) 936-0504
- Fax
- (405) 936-0561
- NPI assigned
- Jan 8, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer L Le, APRN-CNP
- Title
- Provider
- Phone
- (405) 615-8967
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
927 SW D Ave
Lawton, OK 73501-4530
Mailing address
PO Box 57390
Oklahoma City, OK 73157-7390
Phone (405) 506-9101
Other names 1
- LEGACY WELLNESS CENTER
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
2809 NW 31st St
Oklahoma City, OK 73112
Phone (405) 733-0771
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731888000000",
"number": "1033989272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 57390",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731577390",
"telephone_number": "405-506-9101",
"fax_number": "405-936-0561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "927 SW D AVE",
"city": "LAWTON",
"state": "OK",
"postal_code": "735014530",
"telephone_number": "405-936-0504",
"fax_number": "405-936-0561"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEGACY WELLNESS",
"organizational_subpart": "NO",
"enumeration_date": "2024-01-08",
"last_updated": "2024-11-18",
"certification_date": "2024-11-18",
"status": "A",
"authorized_official_last_name": "LE",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PROVIDER",
"authorized_official_telephone_number": "405-615-8967",
"authorized_official_credential": "APRN-CNP"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "LEGACY WELLNESS CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.