Healthcare Provider Details

I. General information

NPI: 1467621755
Provider Name (Legal Business Name): KIRBY LOGAN QBHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

IV. Provider business mailing address

3302 E MOORE AVE OFC 5
SEARCY AR
72143-5099
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2020
  • Fax:
Mailing address:
  • Phone: 501-236-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: