Provider Demographics
NPI:1477084259
Name:LOUGHRAN, JESSA
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:
Last Name:LOUGHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MIDDLEGROUND WAY
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9175
Mailing Address - Country:US
Mailing Address - Phone:606-224-3949
Mailing Address - Fax:606-657-5470
Practice Address - Street 1:21 MIDDLEGROUND WAY
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-9175
Practice Address - Country:US
Practice Address - Phone:606-224-3949
Practice Address - Fax:606-657-5470
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator