Provider Demographics
NPI:1407245111
Name:LOUGHRAN, WILLIAM ROBERT RIDER (CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT RIDER
Last Name:LOUGHRAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:RIDER
Other - Last Name:LOUGHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2350 HARRIET LANE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-991-1615
Mailing Address - Fax:972-518-2100
Practice Address - Street 1:6225 N. STATE HIGHWAY 161 STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2223
Practice Address - Country:US
Practice Address - Phone:214-687-0001
Practice Address - Fax:972-518-2100
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1116225367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100369910Medicaid