Provider Demographics
NPI:1629043278
Name:LOGAN, NANCY M (APRN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:LOGAN
Suffix:
Gender:F
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:500-258-8949
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:720 W HILL ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2216
Practice Address - Country:US
Practice Address - Phone:502-636-3164
Practice Address - Fax:502-634-3731
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7802785100Medicaid
KY7802785100Medicaid
KYP27954Medicare UPIN