Provider Demographics
NPI:1265141261
Name:LOGAN, COLEEN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:COLEEN
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 KINKEAD RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7704
Mailing Address - Country:US
Mailing Address - Phone:580-235-7735
Mailing Address - Fax:
Practice Address - Street 1:111 W FORREST AVE STE C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3205
Practice Address - Country:US
Practice Address - Phone:918-490-7011
Practice Address - Fax:918-490-7015
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK210867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily