Provider Demographics
NPI:1336556802
Name:LOGSDON, BRIANNE NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:NICOLE
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 GLEN DALE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1167
Mailing Address - Country:US
Mailing Address - Phone:304-639-2459
Mailing Address - Fax:
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-845-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF0714495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily