MEDICARE: MRS. EMILY KYLE LOGAN MSN, APRN

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	363L00000X	Nurse Practitioner	226014	AR
2	363L00000X	Nurse Practitioner	APN0000027176	TN

General Provider Information

NPI Number	:	1669009007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY KYLE LOGAN MSN, APRN

Provider Business Mailing Address
First Line	:	4806 BAKERSFIELD DR
Second Line	:
City	:	NESBIT
State	:	MS
Zip	:	38651-6013
Country	:	US
Telephone Number	:	901-490-7046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 WESLEY DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-6499
Country	:	US
Telephone Number	:	901-516-3700
Fax Number	:

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	04/12/2024

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