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General NPI Number Information
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NPI Number | 1659747392
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Entity Type | Individual
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Provider Name | JESSICA LOGSDON LPN
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 1726 DRIPPING SPRING PT
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City | VAN BUREN
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State | AR
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Zip | 72956-8159
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Country | US
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Telephone | 479-430-1703
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7076
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City | VAN BUREN
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State | AR
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Zip | 72956-0123
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Country | US
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Telephone | 479-430-1703
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Fax | 479-763-3229
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L43661
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License Number State | AR
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