Basic Information
| Provider Information | |||||||||
| NPI: | 1265734164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 829 HALBERT ST | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721042607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013324400 | ||||||||
| FaxNumber: | 5013324403 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719014624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016207841 | ||||||||
| FaxNumber: | 5016207843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2010 | ||||||||
| LastUpdateDate: | 11/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L50630 | AR | Y | Nursing Service Providers | Licensed Practical Nurse | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.