Individual
TINA MARIE LEGAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
12330 METCALF AVE STE 580, OVERLAND PARK, KS 66213-1308
(913) 317-3230
Mailing address
901 E 104TH ST, MAILSTOP 400S, KANSAS CITY, MO 64131
(913) 317-3230
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2022007298
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
5380970
KS
363LA2200X
Adult Health Nurse Practitioner
TMP-160593
KS
Other
Enumeration date
02/16/2022
Last updated
04/21/2022
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