Healthcare Provider Details

I. General information

NPI: 1598276644
Provider Name (Legal Business Name): PAMELA D LOGAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 E MAIN ST
FLOYD VA
24091-2620
US

IV. Provider business mailing address

706 E MAIN ST
FLOYD VA
24091-2620
US

V. Phone/Fax

Practice location:
  • Phone: 540-745-8700
  • Fax: 540-745-8701
Mailing address:
  • Phone: 540-745-8700
  • Fax: 540-745-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: