Organization · Type 2 NPI

Radiance Health & Wellness Clinic Mo-Ks

Psychiatric/Mental Health Nurse Practitioner · Raytown, MO

NPI number 1407633902 Active

Practice location

6225 Raytown Trfy
Raytown, MO 64133-3846

Call (816) 510-4549 Map

Mailing address

12641 Antioch Rd # 1053
Overland Park, KS 66213-1701

Specialties and licenses

Taxonomy	Code	License
Psychiatric/Mental Health Nurse Practitioner Primary	363LP0808X	None listed

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

Another provider at this address

Tapan K. Chaudhri, MDSleep Medicine (Internal Medicine) Physician Raytown, MO NPI 1447476957

NPI record

NPI: 1407633902
Entity type: Organization (Type 2)
Issued: Sep 11, 2023
Last updated: Jul 29, 2025
Status: Active

Other names

<unavail>
Radiance Health & Wellness · doing business as
Radiance Health & Wellness · doing business as

Authorized official

Amie Fabah, DNP
DR Ezeogu
(816) 510-4549

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.

Is this your record? How to update it.

About NPI 1407633902

Radiance Health & Wellness Clinic Mo-Ks's National Provider Identifier is 1407633902, issued on Sep 11, 2023. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Raytown, MO. The record was last updated on Jul 29, 2025.