Jeremy D Logsdon, CNP- FAMILY
Individual provider Active NPI Family Nurse Practitioner · Alva, OK
NPI 1013574789 · NPPES record last updated Dec 28, 2022
Key facts
- NPI
- 1013574789
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 86008 (OK)
- Practice address
- 604 Choctaw St
Alva, OK 73717-1626 - Phone
- (580) 327-1118
- Fax
- (580) 327-3067
- NPI assigned
- May 28, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
515 College Ave
Suite 3
Alva, OK 73717-2230
Phone (405) 936-0504
Hospital & facility affiliations
- Share Medical Center
- Integris Health Enid Hospital
- St Mary'S Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190812001791 | OK | Practitioner - Nurse Practitioner | 1658608880 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86008 | OK | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alva Health and Wellness PLLC | Current |
Accepting new patients | |
| State of Oklahoma | Past | Accepting new patients | |
| State of Oklahoma | Past | Accepting new patients |
Locations
515 College Ave
Ste 3
Alva, OK 73717
Phone (580) 747-0296
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 86008 | OK | Yes |
Addresses
Primary practice location
604 Choctaw St
Alva, OK 73717-1626
Mailing address
604 Choctaw St
Alva, OK 73717-1626
Phone (580) 327-1118
Other providers in Alva, OK
- Joshua Joseph Lange-Casillas
- Larry G. Smith, D.D.S., Inc.
- Terri Leeper
- Erin Lehr
- Linda K McMurphy MD PLLC
- Gary Gene Lott
- Crystal Lovinggood
- Steve M Madrid
- Misty J Magnison
- Amber Lynn Maier
All providers in Alva, OK · Family Nurse Practitioner in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.