MEDICARE: J. LOGAN NP IN PSYCHIATRY 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1033042791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. LOGAN NP IN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	22 ROSEMONT ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-2405
Country	:	US
Telephone Number	:	802-236-2611
Fax Number	:	802-236-2611

Provider Business Practice Location Address
First Line	:	22 ROSEMONT ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-2405
Country	:	US
Telephone Number	:	802-236-2611
Fax Number	:	802-236-2611

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER LOGAN
Credential	:	PMHNP
Telephone Number	:	802-236-2611

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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