DR. JACOB DOUGLAS ANDERSON (NPI# 1316329220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316329220 |
| Entity Type | Individual |
| Full Name | DR. JACOB DOUGLAS ANDERSON |
| Credential | DNP |
| Practice Address |
630 E 1400 N Ste 150 Logan UT 84341-2549 |
| Mailing Address |
740 S Woodruff Ave Idaho Falls ID 83401-5285 |
| Practice Telephone | 4359154465 |
| Practice Fax Number | 4357878509 |
| Mailing Telephone | 2085429111 |
| Mailing Fax Number | 2085429114 |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2020-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities | ||
| N | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
Ambulatory Health Care Facilities | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
7942683-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | NPI | 1205300407 | 01 |
| ID | STATE | 833011825 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 700 S Highway 91, Richmond, UT 843331209 | 4352942960 | 4352942960 |
| 740 S Woodruff Ave, Idaho Falls, ID 834015285 | 2085429111 | 2085429114 |
| 2761 Commercial Way, Rock Springs, WY 829014753 | 3073823064 | 3073823303 |
| 507 S Main St, Hailey, ID 833338929 | 2087884122 | 2087886430 |
| 7017 S. Daisy Lane, Idaho Falls, ID 834025753 | 2085345878 | 2085345716 |
| 1404 Pomerelle Ave Ste A1, Burley, ID 833182013 | 2088788783 | 2088788786 |
| 1201 S Main St Ste 110, Logan, UT 843218504 | 4357878504 | 4357993664 |
| 1952 Harrison Drive, Evanston, WY 829303241 | 3072880404 | 3072882810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346802253 | Jacob Anderson | Behavior Technician | 1905 Daniels St Apt 10, Vancouver, WA 98660-2500 | 2019-07-01 |
| 1942619374 | Jacob Ray Anderson | Physical Therapist | 1110 Civic Center Blvd Ste. 502, Yuba City, CA 95993 | 2014-08-11 |
| 1356621163 | Jacob Stewart Anderson | Occupational Therapist | 1899 Tate Blvd Se Ste 2106, Hickory, NC 28602 | 2011-08-24 |
| 1902020761 | Jacob Christian Anderson | Occupational Therapist | 301 Nobles Ln, Old Orchard Beach, ME 04064-1627 | 2007-04-12 |
| 1659830669 | Jacob Anderson | Radiology | 600 Highland Ave, Madison, WI 53792-3440 | 2019-03-19 |
| 1891264990 | Jacob M Anderson | Behavior Technician | 41521 W 11 Mile Rd, Novi, MI 48375-1803 | 2018-11-19 |
| 1538658158 | Jacob Boone Anderson | Student in an Organized Health Care Education/Training Program | 1514 Jefferson Hwy, New Orleans, LA 70121-2483 | 2018-05-09 |
| 1023507035 | Jacob Anderson | Family Medicine | 902 Lakeview Ave, Pueblo, CO 81004-3597 | 2018-05-04 |
| 1710494687 | Jacob Kyle Anderson | Nurse Anesthetist, Certified Registered | 1906 Belleview Ave Se, Roanoke, VA 24014-1838 | 2018-01-02 |
| 1104351709 | Jacob Anderson | Case Manager/Care Coordinator | 142 W Main St, Durant, OK 74701-5008 | 2017-04-21 |
| Street Address |
630 E 1400 N STE 150 |
| City | LOGAN |
| State | UT |
| Zip Code | 84341-2549 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598866691 | Devon E. Dahlke | Emergency Medicine | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2006-09-25 |
| 1629679048 | Shawn Robert Israelsen | Social Worker | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2020-11-03 |
| 1487269080 | Sean Nicholas Wright | Physician Assistant | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2020-09-10 |
| 1639713589 | Sterling Provider Group | Clinic/Center | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2019-11-04 |
| 1134697477 | Adam Garfield | Physician Assistant | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2018-11-05 |
| 1265807614 | Sterling Medical LLC | Clinic/Center | 630 E 1400 N Ste 150, Logan, UT 84341-2534 | 2015-12-10 |
| 1134567282 | Tod Michael Morrison | Nurse Practitioner | 630 E 1400 N Ste 150, Logan, UT 84341-2549 | 2013-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538701529 | Aubrey Salmond | Registered Nurse | 500 East 1500 N, Logan, UT 84341 | 2019-10-11 |
| 1043702046 | Eye Pros of Logan LLC | Optometrist | 1475 N Main St Ste 103, Logan, UT 84341 | 2018-06-05 |
| 1275050452 | Rylie Jeanne Cook | Student in an Organized Health Care Education/Training Program | 11 Aggie Village Apt. J, Logan, UT 84341 | 2017-08-28 |
| 1093262156 | Jessica Lynn Mcgarry | Social Worker | 1040 N 130 W, Apt 100, Logan, UT 84341 | 2016-09-07 |
| 1740663566 | Paul R Gregory | Occupational Therapy Assistant | 1300 N 500 E Suite 120, Suite 120, Logan, UT 84341 | 2015-06-30 |
| 1851708846 | Bradley Budge | Optometrist | 535 E 1400 N Ste 130, Logan, UT 84341 | 2014-07-22 |
| 1386058709 | Daniel Raymond Carlson | Physician Assistant | 500 E. 1400 N., Logan, UT 84341 | 2014-06-13 |
| 1902220239 | Work Injury Solutions Inc. | Clinic/Center | 630 E 1400 N Ste 140, Logan, UT 84341 | 2014-02-06 |
| 1750627287 | Lee Martin Williams Sr. | Counselor | 186 E. 1800 N., North Logan, UT 84341 | 2013-01-03 |
| 1669747804 | Ronald J Payne | Internal Medicine | 1726 North 1850 East, North Logan, UT 84341 | 2012-03-21 |
| Find all providers in zip 84341 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811519085 | Savannah Alder | Nurse Practitioner | 82 N 1250 E, Logan, UT 84321-4920 | 2020-05-11 |
| 1912537887 | Kathryn Grace Quezada | Nurse Practitioner | 165 E 100 N Apt E, Logan, UT 84321-4630 | 2020-01-20 |
| 1104395375 | William Ray Watkins Jr. | Nurse Practitioner | 214 Hanging Rock Hwy, Logan, WV 25601-5102 | 2018-11-17 |
| 1841783727 | Erica Lupson | Nurse Practitioner | 3 Mile Curve, Logan, WV 25601 | 2018-06-14 |
| 1265959704 | Benjamin Tackett | Nurse Practitioner | 140 Stollings Ave Ste 1, Logan, WV 25601-4035 | 2017-08-25 |
| 1295275717 | Jennifer Courtney Coleman | Nurse Practitioner | 25 Mae St, Logan, OH 43138-8965 | 2017-03-02 |
| 1194100701 | Kendall Gilbert Brown | Nurse Practitioner | 1225 Valley View Dr, Logan, UT 84321-4585 | 2015-07-24 |
| 1255731014 | Donalee Thomson | Nurse Practitioner | 850 E 1200 N 9100 Old Main Hl, Logan, UT 84322-9100 | 2014-08-29 |
| 1265717250 | Martin L. Codispoti | Nurse Practitioner | 122 Nick Savas Dr, Logan, WV 25601-3468 | 2011-10-21 |
| 1922242262 | Cynthia Lynn Hazelwood | Nurse Practitioner | 2310 N 400 E Ste A, Logan, UT 84341-1796 | 2009-04-30 |
| Find all providers in LOGAN | ||||
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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.