MR. JACK LOGAN JR. KEITH (PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1982968210
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,261 NURSE PRACTITIONER in WA
Provider Addresses for MR. JACK LOGAN JR. KEITH (PMHNP)
3857 MARTIN WAY E
OLYMPIA, WA 98506
Phone: (253) 581-7020
Type: Location
6102 84TH AVENUE CT W
UNIVERSITY PLACE, WA 984674042
Phone: (360) 870-5411
Fax: (888) 414-8151
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-09-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20220711000995 | I | Nurse Practitioner | OR | TBD |
| I20220913003189 | I | Nurse Practitioner | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 98506)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | MN | |
| Clinical Social Worker | UT | |
| Clinical Social Worker | WA | |
| - | WA | |
| - | CA | |
| Nurse Practitioner | WA | |
| Mental Health Counselor | WA | |
| Nurse Practitioner | OR | |
| - | WA | |
| - | WA |
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