Kimber Janine Logan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1569 Issued in TN

Practice address

315 N Washington Ave
Suite 175
Cookeville, TN 38501-2603

Phone

(931) 528-3300

Fax

(931) 372-2102

NPI assigned

Jan 7, 2008

Sex

Female

Sole proprietor

Yes

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 TN

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

Physician Assistant

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.

• Emergency Services Corporation of America

  dba Physician's Urgent Care

  • Urgent Care Clinic/Center
  • Cookeville, TN
  • NPI 1841338753
  NPD

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1467637736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N WASHINGTON AVE",
            "address_2": "SUITE 175",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012603",
            "telephone_number": "931-528-3300",
            "fax_number": "931-372-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 N WASHINGTON AVE",
            "address_2": "SUITE 175",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012603",
            "telephone_number": "931-528-3300",
            "fax_number": "931-372-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "KIMBER",
        "middle_name": "JANINE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-07",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3665193",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPPER CUMBERLAND RURAL HEALTH LLC",
            "identifier": "621307839",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hillary Danielle Locke, MA
• Amanda Loeffler, CNM
• Jocelyn Margret Loftis, RN
• Lynda Marie Loftis, LADAC
• Mark A Loftis, M.A., S.P.E.
• Mary Caroline Loghry, M.D.
• Jennifer Loh
• April Danielle Looper, PA-C
• Leslie Looper, RN
• Rebeca Lopez Hernandez

• Physician Assistant in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.