Individual ProviderNancy M LoganNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address720 W Hill St, Louisville, KY 40208-2216(502) 636-3164(500) 258-8949PECOS EnrollmentBased on the most recent information from CMS, provider Nancy M Logan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1629043278Provider TypeIndividualFull NameLogan, Nancy MCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date2/17/2006Last Updated11/4/2014Contact InformationPractice LocationPractice Address720 W Hill St, Louisville, KY 40208-2216Phone(502) 636-3164Fax(502) 634-3731Mailing LocationMailing AddressPO Box 950202, Louisville, KY 40295-0202Phone(500) 258-8949Fax(502) 272-5116Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense3002785KentuckyProvider IdentifiersIDDescriptionIssuerID7802785100DescriptionMedicaidIssuerUnlistedKentucky