Provider Demographics
NPI:1649817362
Name:LOGSDON, DUSTY MARIE (APRN)
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:MARIE
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1917
Mailing Address - Country:US
Mailing Address - Phone:270-590-9658
Mailing Address - Fax:270-590-9658
Practice Address - Street 1:203 2ND ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1917
Practice Address - Country:US
Practice Address - Phone:270-590-9658
Practice Address - Fax:270-590-9658
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2019-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty