Provider Demographics
NPI:1396288411
Name:MATTHEWS, LOGAN (APRN)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 HIGHWAY 412 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-8010
Mailing Address - Country:US
Mailing Address - Phone:479-215-3070
Mailing Address - Fax:
Practice Address - Street 1:3721 HIGHWAY 412 E
Practice Address - Street 2:SUITE A
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-8010
Practice Address - Country:US
Practice Address - Phone:479-215-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004933363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health