Lazedrick Logan, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1032186 Issued in TX

Practice address

4131 N Central Expy Ste 900
Dallas, TX 75204-2120

Phone

(800) 909-7140

NPI assigned

Aug 30, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1504051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663372800000",
    "number": "1740708676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 N CENTRAL EXPY STE 900",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752042120",
            "telephone_number": "800-909-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 N CENTRAL EXPY STE 900",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752042120",
            "telephone_number": "800-909-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "LAZEDRICK",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-30",
        "last_updated": "2022-09-17",
        "certification_date": "2022-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "829535",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1032186",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95008515",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1032186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne Logan, LMSW
• Christopher Paul Logan, LPC, LCDC
• Diana Weir Logan, FNP
• Jennie Marie-Tolson Logan, MPT
• Kinsey Claren Logan, M.S. SLP
• Rebecca Logan, PA-C
• Muruga Anand Loganathan, M.D.
• Logic Tech LLC
• Logos Clinical Laboratory LLC
• Samantha Lograsso, FNP

• Psychiatric/Mental Health Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.