Provider Demographics
NPI:1740241413
Name:COOKSLEY, LOGINA E J (ARNP-C)
Entity Type:Individual
Prefix:
First Name:LOGINA
Middle Name:E J
Last Name:COOKSLEY
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-1214
Mailing Address - Country:US
Mailing Address - Phone:620-896-7306
Mailing Address - Fax:620-896-7127
Practice Address - Street 1:615 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1214
Practice Address - Country:US
Practice Address - Phone:620-896-7306
Practice Address - Fax:620-896-7127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44494363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP38169Medicare UPIN
KS160589Medicare ID - Type Unspecified