Organization
LOGAN FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
1719 NASHVILLE ST, RUSSELLVILLE, KY 42276-7804
(270) 726-7664
Mailing address
680 S 4TH ST, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
07/19/2021
Last updated
06/26/2025
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