Organization
LEGACY FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY WHITE (CREDENTIALING SPECIALIST)
(304) 688-7027
Entity
Organization
Contact information
Practice address
1113 2ND AVE, WEST LOGAN, WV 25601-3309
(304) 752-1900
(304) 752-0188
Mailing address
1113 2ND AVE, WEST LOGAN, WV 25601-3309
(304) 752-1900
(304) 752-0188
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN66417
FNP
WV
Enumeration date
03/05/2022
Last updated
09/16/2025
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