Provider Demographics
NPI:1275316804
Name:LOGGAINS, LISA DIANE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:LOGGAINS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 COUNTY ROAD 700
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8123
Mailing Address - Country:US
Mailing Address - Phone:870-335-6145
Mailing Address - Fax:
Practice Address - Street 1:1021 NEIL DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4462
Practice Address - Country:US
Practice Address - Phone:870-898-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine