# LOGAN FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285207241
- **Authorized official:** JOHNETTA TRAYLOR (AO)
- **Authorized official phone:** (502) 596-6063

## Contact information

- **Practice address:** 1719 NASHVILLE ST, RUSSELLVILLE, KY 42276-7804
- **Practice address phone:** (270) 726-7664
- **Mailing address:** 680 S 4TH ST, LOUISVILLE, KY 40202-2407
- **Mailing address phone:** (502) 596-6063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/19/2021
- **Last updated:** 06/26/2025