Provider Demographics
NPI:1376050591
Name:LOGAN, KAREN LEIGH (AGNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:LOGAN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 FOX CHASE LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8579
Mailing Address - Country:US
Mailing Address - Phone:434-660-2887
Mailing Address - Fax:
Practice Address - Street 1:750 FOX CHASE LN
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8579
Practice Address - Country:US
Practice Address - Phone:434-660-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007321363LP2300X
VA0024175657363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care