Healthcare Provider Details

I. General information

NPI: 1053191338
Provider Name (Legal Business Name): SALINA M LOGGINS NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

766 LAWRENCE RD
JACKSON MS
39206-4920
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 888-398-1151
Mailing address:
  • Phone: 601-260-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906210
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: