Provider Demographics
NPI:1184133365
Name:LEGLER, KETURAH (CPNP)
Entity type:Individual
Prefix:
First Name:KETURAH
Middle Name:
Last Name:LEGLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KETURAH
Other - Middle Name:LEE
Other - Last Name:LEGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:2120 CENTERPOINTE WEST DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8487
Practice Address - Country:US
Practice Address - Phone:928-778-4581
Practice Address - Fax:928-776-1872
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005555363LP0200X
AZ306601363L00000X
CA95005555363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210438Medicaid