Provider Demographics
NPI:1215063987
Name:LOGAN, POLLY JEWELL (CNM)
Entity type:Individual
Prefix:MS
First Name:POLLY
Middle Name:JEWELL
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13523 HARGRAVE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3829
Mailing Address - Country:US
Mailing Address - Phone:281-206-4496
Mailing Address - Fax:281-206-4487
Practice Address - Street 1:201 KINGWOOD MEDICAL DR.
Practice Address - Street 2:SUITE B-300
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516618367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife