Look up the most recent NPI and PECOS records

Logan Ledbetter

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3 Medical Plaza Dr, Roseville, CA 95661-3087

PECOS Enrollment

Based on the most recent information from CMS, provider Logan Ledbetter is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1457883068
Provider Type
Individual
Full Name
Ledbetter, Logan
Credential
RD, CNSC

Gender
Male
Sole Proprietor
No
Enumeration Date
4/2/2017
Last Updated
3/5/2025

Contact Information

Practice Location

3 Medical Plaza Dr, Roseville, CA 95661-3087

(916) 774-8885

Unlisted Fax

Mailing Location

PO Box 255228, Sacramento, CA 95865-5228

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 1178331 California
Code 133V00000X	Description Dietitian, Registered Dietary & Nutritional Service Providers	License 86006556 California

Provider Identifiers

ID	Description	Issuer
ID 1457883068	Description Medicaid	Issuer Unlisted California

Logan Ledbetter

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Nemolyaev, Sergey A.

Moede, Julie Catheryn

Nelson, Gary Duane

Lee, Bei Bei

Snarr, Matthew

Moser, Rodney L

Roe, Marian Downey

Ngo, Becky Tran

Mccoy, Michael Lee

Nugent, Christopher P