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General NPI Number Information
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NPI Number | 1407633902
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Entity Type | Organization
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Legal Business Name | RADIANCE HEALTH & WELLNESS CLINIC MO-KS
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 6225 RAYTOWN TRFY
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City | RAYTOWN
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State | MO
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Zip | 64133-3846
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Country | US
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Telephone | 816-510-4549
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Fax |
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Provider Business Mailing Address
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Address Line | 12641 ANTIOCH RD # 1053
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City | OVERLAND PARK
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State | KS
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Zip | 66213-1701
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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 | DR EZEOGU
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Name | AMIE FABAH
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Credential | DNP
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Telephone | 816-510-4549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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