Healthcare Provider Details

I. General information

NPI: 1760813844
Provider Name (Legal Business Name): KAREN LOGAN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 WOODLAWN DR
BYRDSTOWN TN
38549-2317
US

IV. Provider business mailing address

1013 WOODLAWN DR
BYRDSTOWN TN
38549-2317
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-3178
  • Fax: 931-864-3376
Mailing address:
  • Phone: 931-864-3178
  • Fax: 931-864-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number74934
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: