Legacy Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LEGACY FAMILY MEDICINE LLC

Practice address

1113 2ND Ave
West Logan, WV 25601-3309

Phone

(304) 752-1900

Fax

(304) 752-0188

NPI assigned

Mar 5, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wendy White

Title

Credentialing Specialist

Phone

(304) 688-7027

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Watkins, RN, BSN, MSN, FNP-BC

  • Nurse Practitioner
  • Logan, WV
  • NPI 1790272607

  WV

  Medicare reassignment Care Compare group NPD
• William Ray Watkins Jr., RN, MSN, NP

  • Family Nurse Practitioner
  • Logan, WV
  • NPI 1104395375

  WV

  Medicare reassignment Care Compare group NPD
• Kathy Diann Harvey, DO

  • Pediatrics Physician
  • Logan, WV
  • NPI 1720036817
  NPD (past)
• Alicia Marie Grassley, ARNP

  • Family Nurse Practitioner
  • Des Moines, IA
  • NPI 1508560988
  NPD (past)
• Michon Dianne Leddy, PA-C

  • Physician Assistant
  • Clive, IA
  • NPI 1033190467
  NPD (past)
• Rebecca McCann, NP

  • Nurse Practitioner
  • Creston, IA
  • NPI 1417350257
  NPD (past)
• Samantha Dawn Pate, ARNP

  • Nurse Practitioner
  • Panama City, FL
  • NPI 1720613979
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757980800000",
    "number": "1043967466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 2ND AVE",
            "city": "WEST LOGAN",
            "state": "WV",
            "postal_code": "256013309",
            "telephone_number": "304-752-1900",
            "fax_number": "304-752-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 2ND AVE",
            "city": "WEST LOGAN",
            "state": "WV",
            "postal_code": "256013309",
            "telephone_number": "304-752-1900",
            "fax_number": "304-752-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-05",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "304-688-7027"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FNP",
            "identifier": "APRN66417",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandy Alford
• Kayla Marie Ballard
• Patricia D Hensley
• Karunasree Kanuri, M.D.,
• Megan E King
• New Horizon Healthcare
• Summer Nicole New, FNP-BC
• Cynthia Shepherd
• James Stafford
• WV Family Medicine,Inc

• All providers in West Logan, WV
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.