# KELLY J. LOGAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1376592139
- **Gender:** F
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 0533193 | KS | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 2010035953 | MO | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | 48544 | WI | — |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 04/20/2021