Healthcare Provider Details

I. General information

NPI: 1255292819
Provider Name (Legal Business Name): PRACTITIONER SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 DOGPATCH TRADING CTR STE 2
LONDON KY
40741-8292
US

IV. Provider business mailing address

94 DOGPATCH TRADING CTR STE 2
LONDON KY
40741-8292
US

V. Phone/Fax

Practice location:
  • Phone: 606-770-5121
  • Fax: 606-770-5199
Mailing address:
  • Phone: 606-770-5121
  • Fax: 606-770-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REAGEN M LOUGHRAN
Title or Position: OWNER
Credential: APRN
Phone: 606-770-5121