Healthcare Provider Details

I. General information

NPI: 1205743770
Provider Name (Legal Business Name): BREEANN MARIE LOGSDON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREEANN MARIE CLARK

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 5TH AVE
KOTZEBUE AK
99752
US

IV. Provider business mailing address

1225 LAWRENCE RD APT 1033
KEMAH TX
77565-0320
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7334
  • Fax:
Mailing address:
  • Phone: 512-540-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: