Individual
MRS. KIMBERLY LACYNTHIA LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1440 JACKSON LAKE RD, CHATSWORTH, GA 30705-4109
(904) 377-3301
Mailing address
1440 JACKSON LAKE RD, CHATSWORTH, GA 30705-4109
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9166317
FL
363LG0600X
Gerontology Nurse Practitioner
9166317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001458200
—
FL
Enumeration date
07/26/2007
Last updated
09/13/2021
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