Healthcare Provider Details

I. General information

NPI: 1063378891
Provider Name (Legal Business Name): EMILY ALVINA RADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 E EASTLAND CENTER CT STE 200
INDEPENDENCE MO
64055-7023
US

IV. Provider business mailing address

19000 E EASTLAND CENTER CT STE 200
INDEPENDENCE MO
64055-7023
US

V. Phone/Fax

Practice location:
  • Phone: 816-796-7307
  • Fax: 816-796-7305
Mailing address:
  • Phone: 816-796-7307
  • Fax: 816-796-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007001112
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: