MR. LOGAN NIELSON (NPI# 1184199648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184199648 |
| Entity Type | Individual |
| Full Name | MR. LOGAN NIELSON |
| Credential | PA-C |
| Practice Address |
382 N Overland Ave Burley ID 83318-3433 |
| Mailing Address |
300 Dennis Dr Burley ID 83318-3217 |
| Practice Telephone | 2086786996 |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
ID | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 133 W Avenue A, Jerome, ID 833382630 | 2083242004 | |
| 2392 Addison Ave E, Twin Falls, ID 833016745 | 2089334440 |
| Street Address |
382 N OVERLAND AVE |
| City | BURLEY |
| State | ID |
| Zip Code | 83318-3433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790043693 | River View Urgent Care & Medical Center Inc | Clinic/Center | 382 N Overland Ave, Burley, ID 83318-3433 | 2012-04-27 |
| 1649780727 | Chase Beal | Physician Assistant | 382 N Overland Ave, Burley, ID 83318-3433 | 2017-10-03 |
| 1033651989 | Jacob Walker | Physician Assistant | 382 N Overland Ave, Burley, ID 83318-3433 | 2016-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902366834 | Pain & Spine Consultants | Clinic/Center | 1344 Hiland Avenue, Ste A, Burley, ID 83318 | 2019-03-25 |
| 1609335090 | Hurst Medical Pllc | Clinic/Center | 1700 Overland Ave Ste 1, Burley, ID 83318 | 2019-03-15 |
| 1831654243 | Mini-cassia Hearts 4 Seniors | In Home Supportive Care | 135 East 23rd Drive, Burley, ID 83318 | 2019-02-11 |
| 1841760493 | Burley Family Dental Pllc | Dentist | 2200 Parke Ave Ste 2, Burley, ID 83318 | 2018-11-27 |
| 1831634823 | Skye Fahnlander | Occupational Therapy Assistant | 2303 Parke Ave, Burley, ID 83318 | 2016-12-29 |
| 1285024497 | Albion Valley Health Clinic Inc. | Clinic/Center | 400 West 5th Street, Burley, ID 83318 | 2015-01-26 |
| 1124372370 | A Plus Solutions Center | Clinic/Center | 2311 Parke Ave. Unit 3, Suite 12, Burley, ID 83318 | 2012-11-08 |
| 1831442805 | A Plus Solutions Developmental Center LLC | Day Training, Developmentally Disabled Services | 2251 Overland Avenue, Suite Number 5, Burley, ID 83318 | 2012-10-16 |
| 1619258159 | Keleah Margrete Goldammer | Occupational Therapist | 2303 Parke Avenue, Burley, ID 83318 | 2011-08-29 |
| 1932490984 | Tamera Chatburn | Counselor | 531 East 5th St., Preferred Child and Family Services, Burley, ID 83318 | 2011-04-26 |
| Find all providers in zip 83318 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871060681 | Travis Henman | Physician Assistant | 1404 Pomerelle Ave Ste 150, Burley, ID 83318-2012 | 2018-10-30 |
| 1457451486 | Michael J Barbo | Physician Assistant | 1404 Pomerelle Ave Ste A1, Burley, ID 83318-2013 | 2006-09-22 |
| 1033651989 | Jacob Walker | Physician Assistant | 382 N Overland Ave, Burley, ID 83318-3433 | 2016-11-09 |
| 1295105633 | Brandon Pope | Physician Assistant | 1501 Hiland Ave, Burley, ID 83318-2688 | 2015-09-28 |
| 1356644082 | Carin Melissa Howard | Physician Assistant | 1308 Bennett Ave, Burley, ID 83318-2665 | 2010-12-20 |
| 1972560480 | Ellen K Judd | Physician Assistant | 1308 Bennett Ave, Burley, ID 83318-2665 | 2006-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689217911 | David Jeffrey Hanson | Physician Assistant | 740 Mckinley Ave Ste 100, Kellogg, ID 83837-2693 | 2019-10-18 |
| 1952889685 | Cody Mattingly | Physician Assistant | 14601 S Pleasant Valley Rd, Kuna, ID 83634-2728 | 2018-08-03 |
| 1992174072 | Alexa Rhea | Physician Assistant | 2841 Juniper Dr Ste 2, Lewiston, ID 83501-4719 | 2015-09-18 |
| 1043689441 | Derek R Wynn | Physician Assistant | 607 W Main Street, Grangeville, ID 83530 | 2015-09-16 |
| 1407223274 | Michael Kenneth Wucinich | Physician Assistant | 775 Pole Line Rd W Ste 302, Twin Falls, ID 83301-5823 | 2015-08-28 |
| 1811364177 | Ashley Laren Popadics | Physician Assistant | 1510 12th Ave Rd Ste 200, Nampa, ID 83686-6008 | 2015-08-21 |
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1447652813 | Jessea Camille Whitlow | Physician Assistant | 2392 Addison Ave E, Twin Falls, ID 83301-6745 | 2014-09-17 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1609204890 | Rachel Sawyer | Physician Assistant | 7405 Wild Horse Way, Nampa, ID 83686-5496 | 2013-10-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.