Basic Information
Provider Information | |||||||||
NPI: | 1902247992 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOGSDON | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | HARP | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HARP | ||||||||
OtherFirstName: | MELISSA | ||||||||
OtherMiddleName: | ELAINE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APRN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1080 | ||||||||
Address2: |   | ||||||||
City: | BURKESVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 427171080 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2708586655 | ||||||||
FaxNumber: | 2708584027 | ||||||||
Practice Location | |||||||||
Address1: | 220 INTERSTATE PLAZA RD STE D | ||||||||
Address2: |   | ||||||||
City: | MUNFORDVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 427658400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2705242889 | ||||||||
FaxNumber: | 2705242893 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2013 | ||||||||
LastUpdateDate: | 06/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/10/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3008163 | KY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 7100255190 | 05 | KY |   | MEDICAID |