Provider Demographics
NPI:1669009007
Name:LOGAN, EMILY KYLE (MSN, APRN)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KYLE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 BAKERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NESBIT
Mailing Address - State:MS
Mailing Address - Zip Code:38651-6013
Mailing Address - Country:US
Mailing Address - Phone:901-490-7046
Mailing Address - Fax:
Practice Address - Street 1:1300 WESLEY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6499
Practice Address - Country:US
Practice Address - Phone:901-516-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226014363L00000X
TNAPN0000027176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner