Provider Demographics
NPI:1760813844
Name:LOGAN, KAREN (LPN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-2317
Mailing Address - Country:US
Mailing Address - Phone:931-864-3178
Mailing Address - Fax:931-864-3376
Practice Address - Street 1:1013 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549-2317
Practice Address - Country:US
Practice Address - Phone:931-864-3178
Practice Address - Fax:931-864-3376
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74934164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse