Organization · Type 2 NPI

Radiant Medical Clinic of East Texas LLC

Gerontology Nurse Practitioner · Tyler, TX

NPI number 1285454009 Active

Practice location

3613 Rock Creek Dr
Tyler, TX 75707-1635

Specialties and licenses

Taxonomy	Code	License
Gerontology Nurse Practitioner Primary	363LG0600X	None listed

Gerontology Nurse Practitioner: Definition to come...

Another provider at this address

Beulah Home Health Agency IncHome Health Agency Tyler, TX NPI 1942594940

NPI record

NPI: 1285454009
Entity type: Organization (Type 2)
Issued: Oct 16, 2024
Last updated: Oct 16, 2024
Status: Active
Subpart: Yes of Radiant Medical Clinic of East Texas LLC

Other names

Radience Wound Care · doing business as

Authorized official

Mrs. Doris Udosen, APRN
President
(903) 343-7480

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1285454009

Radiant Medical Clinic of East Texas LLC's National Provider Identifier is 1285454009, issued on Oct 16, 2024. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Tyler, TX. The record was last updated on Oct 16, 2024.