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General NPI Number Information
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NPI Number | 1396344115
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Entity Type | Organization
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Legal Business Name | RADIANCE FAMILY CARE LLC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 1262 W AMITY ST
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City | LOUISBURG
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State | KS
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Zip | 66053-7815
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Country | US
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Telephone | 913-747-5374
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Fax |
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Provider Business Mailing Address
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Address Line | 16143 FOSTER ST
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City | OVERLAND PARK
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State | KS
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Zip | 66085-8417
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Country | US
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Telephone | 913-747-5374
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | KELLI ELIZABETH DOCMAN
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Credential | APRN
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Telephone | 913-747-5374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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