Provider Demographics
NPI:1972306454
Name:LOGGINS, JACOB DARBY
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DARBY
Last Name:LOGGINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:DARBY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1760
Mailing Address - Country:US
Mailing Address - Phone:270-780-2680
Mailing Address - Fax:270-780-2691
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-780-2680
Practice Address - Fax:270-780-2691
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program