| Doctor Name: | MRS. KIMBERLY A LOGAN |
| NPI Number: | 1700931342 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNPC |
| License Number: | 210360 |
| Business Practice Address: | 63 State Road Gt Barrington, MA - 012301223 |
| Business Phone Number: | 4136449933 |
| Business Fax Number: | 4136449433 |
| Mailing Address: | 63 State Road, GT BARRINGTON |
| State: | MA |
| Postal Code: | 012301223 |
| Phone Number: | 4136449933 |
| Fax Number: | 4136449433 |
| NPI Enumeration Date: | 01/24/2007 |
| NPI Last Update Date: | 10/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 210360 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |