Provider Demographics
NPI:1578283925
Name:ADAMS, LOGAN KOREY (APRN)
Entity Type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:KOREY
Last Name:ADAMS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76-5833 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:HOLUALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96725-9715
Mailing Address - Country:US
Mailing Address - Phone:214-455-4350
Mailing Address - Fax:
Practice Address - Street 1:75-5722 KUAKINI HWY STE 103
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1721
Practice Address - Country:US
Practice Address - Phone:214-455-4350
Practice Address - Fax:808-444-3478
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-106892-0163WP0808X
HIAPRN-3767-0363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health