Provider Demographics
NPI:1922804335
Name:LOGWOOD, KENNITH
Entity type:Individual
Prefix:
First Name:KENNITH
Middle Name:
Last Name:LOGWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-8144
Mailing Address - Country:US
Mailing Address - Phone:304-222-1367
Mailing Address - Fax:304-255-6736
Practice Address - Street 1:316 LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-8144
Practice Address - Country:US
Practice Address - Phone:304-222-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion