Provider Demographics
NPI:1902247992
Name:LOGSDON, MELISSA HARP (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:HARP
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ELAINE
Other - Last Name:HARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4027
Practice Address - Street 1:220 INTERSTATE PLAZA RD STE D
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-8400
Practice Address - Country:US
Practice Address - Phone:270-524-2889
Practice Address - Fax:270-524-2893
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100255190Medicaid