# LEGACY WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LEGACY WELLNESS CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033989272
- **Authorized official:** JENNIFER L LE APRN-CNP (PROVIDER)
- **Authorized official phone:** (405) 615-8967

## Contact information

- **Practice address:** 927 SW D AVE, LAWTON, OK 73501-4530
- **Practice address phone:** (405) 936-0504
- **Practice address fax:** (405) 936-0561
- **Mailing address:** PO BOX 57390, OKLAHOMA CITY, OK 73157-7390
- **Mailing address phone:** (405) 506-9101
- **Mailing address fax:** (405) 936-0561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/08/2024
- **Last updated:** 11/18/2024