Provider Demographics
NPI:1598230856
Name:LOGSDON, SHELBY LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-6470
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:500 HARRIS DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-3640
Practice Address - Country:US
Practice Address - Phone:513-529-3000
Practice Address - Fax:513-529-1892
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6722207R00000X
OHAPRN.CNP.023888363A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0370761Medicaid