Provider Demographics
NPI:1891965927
Name:LOGSDON, DANA MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:727 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033
Mailing Address - Country:US
Mailing Address - Phone:270-692-2569
Mailing Address - Fax:270-692-9987
Practice Address - Street 1:108 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1827
Practice Address - Country:US
Practice Address - Phone:270-692-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005073363LA2200X
KY3005073P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100236800Medicaid