Provider Demographics
NPI:1821277518
Name:LOUGHRAN, REAGEN M (ARNP)
Entity Type:Individual
Prefix:
First Name:REAGEN
Middle Name:M
Last Name:LOUGHRAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 REUBEN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1074
Mailing Address - Country:US
Mailing Address - Phone:606-862-7000
Mailing Address - Fax:606-864-1207
Practice Address - Street 1:1120 REUBEN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1074
Practice Address - Country:US
Practice Address - Phone:606-862-7000
Practice Address - Fax:606-864-1207
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005415363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care