Individual
BRYAN L. LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
155 VILLAGE DRIVE, SPARTA, MO 65673
(417) 634-4203
(417) 634-4505
Mailing address
PO BOX 183, SPARTA, MO 65753-0183
(417) 634-4203
(417) 634-4505
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
127563
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427457205
—
MO
Enumeration date
07/27/2007
Last updated
01/13/2012
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