Holly Maureen Logan, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Shenandoah, IA
NPI 1295580041 · NPPES record last updated Jul 24, 2024
Key facts
- NPI
- 1295580041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- G179028 (IA)
- Practice address
- 600 W Sheridan Ave
Shenandoah, IA 51601-1708 - Phone
- (712) 246-0159
- Fax
- (712) 581-9084
- NPI assigned
- Apr 23, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Family Connections Inc
Horizon Therapy Group LLC
Practice addresses (Care Compare)
1720 N 16TH St
Suite K
Council Bluffs, IA 51501-0109
Phone (712) 256-4420
300 W Broadway
Suite 270
Council Bluffs, IA 51503-9028
Phone (712) 256-7511
304 S Locust St
Glenwood, IA 51534-1825
Phone (712) 527-2823
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- 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 |
|---|---|---|---|---|
| I20240615000304 | IA | Practitioner - Nurse Practitioner | 5395164925 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Mental Health LLC | Current |
Accepting new patients | |
| Horizon Therapy Group, LLC | Current |
Accepting new patients | |
| Family Connections, Inc | Current |
Accepting new patients |
Locations
1720 N 16th St
Ste K
Council Bluffs, IA 51501
Phone (712) 256-4420
300 W Broadway
Ste 270
Council Bluffs, IA 51503
Phone (712) 256-7511
1977 G Ave
Red Oak, IA 51566
Phone (712) 623-6349
600 W Sheridan Ave
Shenandoah, IA 51601
Phone (712) 246-0159
523 W Sheridan Ave
Shenandoah, IA 51601
Phone (712) 246-0159
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | G179028 | IA | Yes |
Addresses
Primary practice location
600 W Sheridan Ave
Shenandoah, IA 51601-1708
Mailing address
409 E Nishna Rd
Shenandoah, IA 51601-2541
Phone (712) 313-0053
Other practice location 1
1977 G Ave
Red Oak, IA 51566-4474
Phone (712) 623-6349
Other practice location 2
523 W Sheridan Ave
Shenandoah, IA 51601-1705
Phone (712) 246-0159
Other providers in Shenandoah, IA
- Emily Kleier
- Kelly Lynn Kline
- Logan J Kopf
- Angela Sue Ledford
- Darci Lewis
- Jennifer Ann Lundgren
- David Lutz
- Angela Dawn Mace
- Martee R Macleod-Kozal
- Carin Renee Mason
All providers in Shenandoah, IA · Psychiatric/Mental Health Nurse Practitioner in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2024. 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.