Provider Demographics
NPI:1639980543
Name:LOGAN, BALEIGH NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:BALEIGH
Middle Name:NICOLE
Last Name:LOGAN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:BALEIGH
Other - Middle Name:NICOLE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1550
Mailing Address - Country:US
Mailing Address - Phone:606-784-3771
Mailing Address - Fax:
Practice Address - Street 1:316 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1550
Practice Address - Country:US
Practice Address - Phone:606-784-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4034516207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine