MEDICARE: MRS. KIMBERLY A LOGAN FNPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	210360	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700931342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY A LOGAN FNPC

Provider Business Mailing Address
First Line	:	63 STATE ROAD
Second Line	:
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230-1223
Country	:	US
Telephone Number	:	413-644-9933
Fax Number	:	413-644-9433

Provider Business Practice Location Address
First Line	:	63 STATE ROAD
Second Line	:
City	:	GT BARRINGTON
State	:	MA
Zip	:	01230-1223
Country	:	US
Telephone Number	:	413-644-9933
Fax Number	:	413-644-9433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/27/2010

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