Logan Blaze Wilson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP143063 Issued in TX

Practice address

6529 W Plano Pkwy Ste D
Plano, TX 75093-8262

Phone

(972) 781-1414

NPI assigned

Sep 18, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dallas Physician Medical Services for Children Inc

  dba Children's Health Medical Group

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1194153650
  Medicare reassignment NPD
• Dallas Physician Medical Services for Children Inc

  dba Children's Health Medical Group

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1558407908
  NPD
• Complex Care Medical Services Corporation

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1013256098
  NPD (past)
• Pediatric Offices at Willow Bend

  • Specialist
  • Plano, TX
  • NPI 1700045200
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1124678305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6529 W PLANO PKWY STE D",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938262",
            "telephone_number": "972-781-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6529 W PLANO PKWY STE D",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750938262",
            "telephone_number": "972-781-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LOGAN",
        "middle_name": "BLAZE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-18",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP143063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "PENDING",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Wilson, P.T.
• Antwynnique Wilson
• Briana Miguel Wilson
• James Wade Wilson, MD
• Kevin Wilson, PA-C
• Rick Wilson, M.D.
• Rose Mary Wilson, DPM
• Taleesha Wilson
• Taylor Ross Wilson
• Peter John Wiltse, D.O.

• Family Nurse Practitioner in Plano, TX
• Providers in Plano, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.