NPIMap

Organization Active NPI

Legacy Developmental Pediatrics, PLLC

  • Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1295596096
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
LEGACY DEVELOPMENTAL PEDIATRICS, PLLC
Practice address
2505 79TH St Ste B
Lubbock, TX 79423-2211
Phone
(806) 300-8228
Fax
(806) 300-8223
NPI assigned
Jan 18, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Authorized official

Name
Patricia Perez, MSN, APRN, FNP-BCNPI 1396073425
Title
Nurse Practitioner
Phone
(806) 300-8228

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)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

2505 79TH St Ste B
Lubbock, TX 79423-2211

Mailing address

2505 79TH St Ste B
Lubbock, TX 79423-2211
Phone (806) 300-8228

Other names 1

  • Legacy Developmental Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251103003432 TX Part B Supplier - Clinic/Group Practice 7517457146 Receives reassigned benefits from 3 practitioners
Practice locations: Lubbock, TX

National Provider Directory

National Provider Directory

Locations

2403 82nd St
Lubbock, TX 79423
Phone (806) 300-8228

Practitioners & affiliated clinicians

Practitioners 6

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": "1705536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1295596096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 79TH ST STE B",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794232211",
            "telephone_number": "806-300-8228",
            "fax_number": "806-300-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 79TH ST STE B",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794232211",
            "telephone_number": "806-300-8228",
            "fax_number": "806-300-8223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DEVELOPMENTAL PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-18",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "806-300-8228",
        "authorized_official_credential": "MSN, APRN, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Developmental Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.