Healthcare Provider Details

I. General information

NPI: 1225942618
Provider Name (Legal Business Name): REAGAN NICOLE PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S INDEPENDENCE ST
HARRISONVILLE MO
64701-2352
US

IV. Provider business mailing address

306 S INDEPENDENCE ST
HARRISONVILLE MO
64701-2352
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-4010
  • Fax: 816-380-4010
Mailing address:
  • Phone: 816-380-4010
  • Fax: 816-380-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: