Healthcare Provider Details

I. General information

NPI: 1215842166
Provider Name (Legal Business Name): LOGAN EMERALD HARPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HEALTH PKWY
THREE RIVERS MI
49093-8352
US

IV. Provider business mailing address

1825 KENOWA AVE SW
BYRON CENTER MI
49315-8970
US

V. Phone/Fax

Practice location:
  • Phone: 269-278-1145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: