Individual
KIMBERLY LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
32 GIBBS DR, CHALMETTE, LA 70043-4414
(256) 945-5804
(256) 945-5804
Mailing address
3809 TIMWOOD DR NW, HUNTSVILLE, AL 35810-1327
(256) 945-5805
(256) 945-5804
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-2638055
—
LA
Enumeration date
09/15/2021
Last updated
09/15/2021
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