Logan Family Practice LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LOGAN FAMILY PRACTICE LLC

Practice address

1719 Nashville St Ste C
Russellville, KY 42276-7804

Phone

(270) 726-7664

NPI assigned

Oct 1, 2021

Organization subpart

No

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

Authorized official

Name

Johnetta Traylor

Title

Ao

Phone

(502) 596-6063

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Logan Family Practice LLC

  • Family Medicine Physician
  • Russellville, KY
  • NPI 1285207241

  O20210928000378

  Same enrollment

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Bowling Green-Warren County Community Hospital Corporation

  • Rural Health Clinic/Center
  • Russellville, KY
  • NPI 1760228647

  Sold to, 2024-07-01

  CMS change of ownership

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Erinn Lynn Basista, DNP, APRN, FNP-C

  • Family Nurse Practitioner
  • Russellville, KY
  • NPI 1457954471
  NPD
• Melissa D Corbin

  • Nurse Practitioner
  • Russellville, KY
  • NPI 1922678143
  NPD
• Patrick Kevin Hayden, M.D.

  • Family Medicine Physician
  • Russellville, KY
  • NPI 1295847184
  NPD
• Laura Porter-Guyer, PA

  • Physician Assistant
  • Portland, TN
  • NPI 1780771816
  NPD

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1699447169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S 4TH ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "telephone_number": "502-596-6063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 NASHVILLE ST STE C",
            "city": "RUSSELLVILLE",
            "state": "KY",
            "postal_code": "422767804",
            "telephone_number": "270-726-7664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JOHNETTA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "502-596-6063"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lindenberg, MS E.D., ATC
• Logan County Board of Education
• Logan County Eye Associates
• Logan Emergency Group LLC
• Logan Family Practice LLC
• Logan Memorial Hospital
• Logan Memorial Hospital
• Logan Memorial Hospital LLC
• Logan Memorial Hospital LLC
• Logan Memorial Hospital LLC

• Rural Health Clinic/Center in Russellville, KY
• Providers in Russellville, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.