Individual
MR. JACK LOGAN KEITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
6102 84TH AVENUE CT W, UNIVERSITY PLACE, WA 98467-4042
(360) 870-5411
(888) 414-8151
Mailing address
6102 84TH AVENUE CT W, UNIVERSITY PLACE, WA 98467-4042
(360) 870-5411
(888) 414-8151
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
202110580NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61193548
WA
Other
Enumeration date
07/02/2012
Last updated
12/03/2025
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