Individual
LOGAN NICOLE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
329 WESLEY ST, JOHNSON CITY, TN 37601-1772
(423) 631-0055
Mailing address
119 EPPERSON ST, ATHENS, TN 37303-3478
(423) 745-7500
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
30187
TN
Other
Enumeration date
11/11/2021
Last updated
08/10/2022
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