Individual
MS. KIMBER JANINE LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
315 N WASHINGTON AVE, SUITE 175, COOKEVILLE, TN 38501-2603
(931) 528-3300
(931) 372-2102
Mailing address
315 N WASHINGTON AVE, SUITE 175, COOKEVILLE, TN 38501-2603
(931) 528-3300
(931) 372-2102
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1569
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3665193
—
TN
01
—
621307839
UPPER CUMBERLAND RURAL HEALTH LLC
TN
Enumeration date
01/07/2008
Last updated
09/14/2016
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