| Radiance Health & Wellness | |
|
6225 Raytown Trfy Raytown MO 64133-3846 | |
| (816) 510-4549 | |
| Not Available |
| Full Name | Radiance Health & Wellness |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 6225 Raytown Trfy, Raytown, Missouri |
| Authorized Official Name and Position | Amie Fabah (DR EZEOGU) |
| Authorized Official Contact | 8165104549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Health & Wellness 12641 Antioch Rd # 1053 Overland Park KS 66213-1701 Ph: () - | Radiance Health & Wellness 6225 Raytown Trfy Raytown MO 64133-3846 Ph: (816) 510-4549 |
| NPI Number | 1407633902 |
|---|---|
| Provider Enumeration Date | 09/11/2023 |
| Last Update Date | 10/27/2023 |
| Medicare PECOS PAC ID | 6204282874 |
|---|---|
| Medicare Enrollment ID | O20231106000358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407633902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Amie Fabah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336512474 PECOS PAC ID: 4587966841 Enrollment ID: I20231106000449 |
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