=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184517559
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN F. HASKINS PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 MAYSVILLE RD
-----------------------------------------------------
City | MOUNT STERLING
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40353-9767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-497-4144
-----------------------------------------------------
Fax | 859-497-4137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 936
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40743-0936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-330-7835
-----------------------------------------------------
Fax | 859-497-4137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | TC153
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------