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General NPI Number Information
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NPI Number | 1003472804
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Entity Type | Organization
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Legal Business Name | LOGINCLINICS, PLLC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 406 US 1 HWY STE A
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-7847
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Country | US
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Telephone | 919-679-1880
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Fax | 800-507-0902
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Provider Business Mailing Address
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Address Line | 406 US 1 HWY STE A
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-7847
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Country | US
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Telephone | 919-679-1880
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Fax | 800-507-0902
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JACLYN S QUALTER
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Credential | AGPCNP-BC, ACNP-BC
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Telephone | 919-679-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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