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General NPI Number Information
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NPI Number | 1700602364
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Entity Type | Organization
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Legal Business Name | RADIANT PRIME
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Dates
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Enumeration Date | 11/28/2024
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 7075 WADES MILL RD
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City | MOUNT STERLING
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State | KY
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Zip | 40353-8293
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Country | US
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Telephone | 813-384-8050
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Fax | 813-336-8804
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Provider Business Mailing Address
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Address Line | 4948 REFLECTING POND CIR
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City | WIMAUMA
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State | FL
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Zip | 33598-4064
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Country | US
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Telephone | 813-384-8050
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Fax | 813-336-8804
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Authorized Official
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Title or Position | OWNER & CEO
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Name | MRS. JESSICA NICOLE MCGLONE
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Credential | APRN
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Telephone | 813-384-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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