Provider Demographics
NPI:1457149718
Name:LOGAN-JOHNSON, JORDYN EVETTE
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:EVETTE
Last Name:LOGAN-JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 GARLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3223
Mailing Address - Country:US
Mailing Address - Phone:951-761-2129
Mailing Address - Fax:
Practice Address - Street 1:1676 GARLAND WAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3223
Practice Address - Country:US
Practice Address - Phone:951-761-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula