MEDICARE: LOGINCLINICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1003472804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGINCLINICS, PLLC

Provider Business Mailing Address
First Line	:	406 US 1 HWY STE A
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-7847
Country	:	US
Telephone Number	:	919-679-1880
Fax Number	:	800-507-0902

Provider Business Practice Location Address
First Line	:	406 US 1 HWY STE A
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-7847
Country	:	US
Telephone Number	:	919-679-1880
Fax Number	:	800-507-0902

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JACLYN S QUALTER
Credential	:	AGPCNP-BC, ACNP-BC
Telephone Number	:	919-679-1880

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	09/23/2025

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