Provider Demographics
NPI:1699335968
Name:VANSICKLE, LOGAN SCOTT (APRN)
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:SCOTT
Last Name:VANSICKLE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2775
Mailing Address - Country:US
Mailing Address - Phone:270-827-7200
Mailing Address - Fax:
Practice Address - Street 1:411 LETCHER ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4245
Practice Address - Country:US
Practice Address - Phone:270-831-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily