Individual provider Active NPI

Lalaura Louise Logan-Thomas, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Davenport, IA
National Provider Identifier
1598438095
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
G177211 Issued in IA
Practice address
1441 W Central Park Ave
Davenport, IA 52804-1707
Phone
(563) 383-1900
Fax
(563) 328-5690
NPI assigned
Jul 29, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 041387210 IL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X G177211 IA Primary

Addresses

Primary practice location

1441 W Central Park Ave
Davenport, IA 52804-1707

Mailing address

1613 12TH St
Rock Island, IL 61201-3444

Other practice location 1

1613 12th St
Rock Island, IL 61201-3444
Phone (309) 631-1361

Other names 1

  • Ms. Lalaura L Logan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20240201001421 IA Practitioner - Nurse Practitioner 2163875519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vera French Community Mental HealthGroup PAC ID 6103715214, 34 clinicians

Practice addresses (Care Compare)

1441 W Central Park Ave
Davenport, IA 52804-1707
Phone (563) 383-1900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041387210ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Vera French Community Mental Health Single Specialty CurrentSince Jan 1, 2024 Accepting new patients
Vera French Community Mental Health PastSince Dec 10, 2023 Accepting new patients

Locations

852 Middle Rd
Ste 101
Bettendorf, IA 52722
Phone (563) 383-1900

1441 W Central Park Ave
Davenport, IA 52804
Phone (563) 383-1900

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1598438095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1613 12TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612013444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 W CENTRAL PARK AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041707",
            "telephone_number": "563-383-1900",
            "fax_number": "563-328-5690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1613 12th St",
            "address_purpose": "LOCATION",
            "city": "Rock Island",
            "state": "IL",
            "postal_code": "612013444",
            "country_code": "US",
            "telephone_number": "309-631-1361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOGAN-THOMAS",
        "first_name": "LALAURA",
        "middle_name": "LOUISE",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-29",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041387210",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G177211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LALAURA",
            "last_name": "LOGAN",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "MSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.