| NPI | 1558863555 |
|---|---|
| Former Name | KYRA NICOLE LOGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5740) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA11881) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2024-04-26 |