MALLORY ANNE LOGSDON (NPI# 1306183090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306183090 |
| Entity Type | Individual |
| Full Name | MALLORY ANNE LOGSDON |
| Credential | PA-C |
| Practice Address |
5507 S Congress Ave Suite 140 Lake Worth FL 33462-1139 |
| Practice Telephone | 5619656685 |
| Mailing Telephone | 5619656685 |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2014-01-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9106949 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831480896 | Mallory M. Logsdon | Pediatrics | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2011-04-26 |
| Street Address |
5507 S CONGRESS AVE SUITE 140 |
| City | LAKE WORTH |
| State | FL |
| Zip Code | 33462-1139 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104449503 | Brightlife Institute, LLC | Clinic/Center | 2315 Shimmery Lane, Lake Worth, FL 33462 | 2020-05-20 |
| 1760024988 | Woodelyne Marc | Home Health | 1307 Flamingo Dr, Lantan, FL 33462 | 2019-10-09 |
| 1336624428 | Jennifer Lynn Jones | Nurse Practitioner | 5401 S Congress Ave Ste 105, Atlantis, FL 33462 | 2018-09-25 |
| 1427548445 | Publix Super Markets, Inc. | Pharmacy | 262 S Ocean Blvd, Manalapan, FL 33462 | 2018-05-15 |
| 1629567474 | Perfection Rx LLC | Pharmacy | 3248 Lantana Rd, Lake Worth, FL 33462 | 2018-05-08 |
| 1942797824 | Mayra Alejandra Tovar Castro | Student in an Organized Health Care Education/Training Program | 180 Jfk Drive, Suite 210, Atlantis, FL 33462 | 2018-04-17 |
| 1285131169 | Samar Ibrahim Mohamed Huss Aboulenain | Student in an Organized Health Care Education/Training Program | 180 Jfk Drive, Suite 210, Atlantis, FL 33462 | 2018-04-09 |
| 1801392535 | Carla Ortega | Student in an Organized Health Care Education/Training Program | 180 Jkf Drive, Suite 210, Atlantis, FL 33462 | 2018-04-02 |
| 1811427438 | Sonia Camille | Behavior Technician | 49 Sioux Ln, Lantana, FL 33462 | 2017-06-15 |
| 1922536648 | Alyzza De La Uz Forte | Nurse Practitioner | 180 John F Kennedy Dr, 311, Atlantis, FL 33462 | 2017-05-25 |
| Find all providers in zip 33462 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629620034 | Jean B Pierre | Physician Assistant | 5924 Ithaca Cir W, Lake Worth, FL 33463-1518 | 2019-07-15 |
| 1063925154 | Catalina Jimenez | Physician Assistant | 4709 Lucerne Lakes Blvd E Apt 104, Lake Worth, FL 33467-8868 | 2017-11-10 |
| 1487993671 | Sarah Anne Hill Kennedy | Physician Assistant | 5053 S Congress Ave Ste 204, Lake Worth, FL 33461-4706 | 2013-02-07 |
| 1346214251 | Brian Bernard Lambert | Physician Assistant | 6894 Lake Worth Road, Suite #201, Lake Worth, FL 33467 | 2006-02-15 |
| 1477198893 | Bryan Martin | Physician Assistant | 5065 S State Road 7 Ste 203, Lake Worth, FL 33449-5439 | 2019-11-08 |
| 1730627621 | Christian Estevez | Physician Assistant | 3618 Lantana Rd Ste 202, Lake Worth, FL 33462-2247 | 2017-02-10 |
| 1205206232 | Elizabeth Mignano | Physician Assistant | 4640 Hypoluxo Rd, Lake Worth, FL 33463-7534 | 2015-10-02 |
| 1265869440 | Azin Steadman | Physician Assistant | 5401 S Congress Ave, Lake Worth, FL 33462 | 2013-10-02 |
| 1538307509 | Stephanie Rivera | Physician Assistant | 1926 10th Ave N Ste 105, Lake Worth, FL 33461-3300 | 2009-01-29 |
| 1750575932 | Susan Rice Molina | Physician Assistant | 3618 Lantana Rd Ste 100, Lake Worth, FL 33462-2247 | 2007-08-30 |
| Find all providers in LAKE WORTH | ||||
| City | LAKE WORTH |
| Zip Code | 33462 |
Please comment or provide details below to improve the information on MALLORY ANNE LOGSDON.
| 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.