Individual
AMY L LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3231 S NATIONAL AVE, STE 140, SPRINGFIELD, MO 65807-7304
(417) 890-4132
(417) 890-4140
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
149749
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215171368
—
MO
05
—
191965758
—
AR
01
—
431560263
TRICARE
MO
01
—
P01036352
RR MCR
MO
Enumeration date
04/20/2009
Last updated
03/01/2013
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