# LEGACY WELLNESS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Wellness PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912731712
- **Authorized official:** KRISTIN KELLY FNP (PROVIDER)
- **Authorized official phone:** (623) 792-3584

## Contact information

- **Practice address:** 19841 N 27TH AVE STE 204, PHOENIX, AZ 85027-4005
- **Practice address phone:** (623) 792-3584
- **Mailing address:** PO BOX 46, PEORIA, AZ 85380-0046
- **Mailing address phone:** (623) 792-3584

## Taxonomy

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

## Other

- **Enumeration date:** 08/26/2024
- **Last updated:** 08/26/2024