# LEGACY HEALTH CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942670005
- **Authorized official:** HELEN R KLEIN FNP (OWNER)
- **Authorized official phone:** (907) 225-6355

## Contact information

- **Practice address:** 3524 TONGASS AVE, KETCHIKAN, AK 99901-5635
- **Practice address phone:** (907) 225-6355
- **Mailing address:** 3524 TONGASS AVE, KETCHIKAN, AK 99901-5635
- **Mailing address phone:** (907) 225-6355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 1106 | AK | Yes |
| 363LF0000X | Family Nurse Practitioner | 551 | AK | — |

## Other

- **Enumeration date:** 10/01/2015
- **Last updated:** 10/01/2015