Provider Demographics
NPI:1770952806
Name:LOGSDON, RITA A (APRN)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:A
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-230-0182
Mailing Address - Fax:270-230-1420
Practice Address - Street 1:1895 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-9138
Practice Address - Country:US
Practice Address - Phone:270-230-0182
Practice Address - Fax:270-230-0014
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100372850Medicaid
KYK186760Medicare PIN