Basic Information
| Provider Information | |||||||||
| NPI: | 1699789271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGSDON | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E PARRISH AVE | ||||||||
| Address2: | SUITE 101 BLDG B | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 E PARRISH AVE | ||||||||
| Address2: | SUITE 101 BLDG B | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706833232 | ||||||||
| FaxNumber: | 2708521600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LP0200X | 4885P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.