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General NPI Number Information
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NPI Number | 1235966870
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Entity Type | Organization
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Legal Business Name | RADIANT HEALTH & WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 215 N MIDWEST BLVD
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City | MIDWEST CITY
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State | OK
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Zip | 73110-4320
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Country | US
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Telephone | 405-973-5284
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18144
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City | OKLAHOMA CITY
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State | OK
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Zip | 73154-0144
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. HASINA JOHNSON
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Credential | CNP, APRN, FNP-BC
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Telephone | 405-973-5284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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