MEDICARE: LOGAN WOMACK

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	211939	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	41773	TN

General Provider Information

NPI Number	:	1295282465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN WOMACK

Provider Business Mailing Address
First Line	:	713 CHEATHAM ST
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-2828
Country	:	US
Telephone Number	:	615-463-6200
Fax Number	:	615-463-6202

Provider Business Practice Location Address
First Line	:	713 CHEATHAM ST
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-2828
Country	:	US
Telephone Number	:	615-463-6200
Fax Number	:	615-463-6202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	06/12/2026

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Directions to “ LOGAN WOMACK ” Practice Location

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