Provider Demographics
NPI:1942266861
Name:LOGAN, DEBORAH (CNM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNM
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 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-439-4917
Mailing Address - Fax:903-885-7183
Practice Address - Street 1:113 AIRPORT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2193
Practice Address - Country:US
Practice Address - Phone:903-439-4917
Practice Address - Fax:903-885-7183
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775361367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209431001Medicaid
TXS62802Medicare UPIN
TX8L22495Medicare PIN