Kimberly Lacynthia Logan, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9166317 Issued in FL

Practice address

1440 Jackson Lake Rd
Chatsworth, GA 30705-4109

Phone

(904) 377-3301

NPI assigned

Jul 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kimberly Laycinthia Stewart Former name

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Emory University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  FL, GA

  Medicare reassignment NPD
• 21St Century Oncology of Jacksonville LLC

  • Medical Oncology Physician
  • Jacksonville, FL
  • NPI 1215101902
  NPD (past)

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1417147463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 JACKSON LAKE RD",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307054109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 JACKSON LAKE RD",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307054109",
            "telephone_number": "904-377-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "KIMBERLY",
        "middle_name": "LACYNTHIA",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-26",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "9166317",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9166317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001458200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "STEWART",
            "middle_name": "LAYCINTHIA",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Kwee, APRN
• Tonya Leonard
• Jeffery Lewis, CADCII
• Lifetouch Chiropractic LLC
• Living Well Pharmacy #2 Inc
• Chia CHI Loh, MBBS
• Tiffany Suzanne Longley
• Lookout Mountain Community Services
• James Daniel Loughridge
• Anita Lowe

• Family Nurse Practitioner in Chatsworth, GA
• Providers in Chatsworth, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.