| Radiance Family Care Llc | |
|
1262 W Amity St Louisburg KS 66053-7815 | |
| (913) 747-5374 | |
| Not Available |
| Full Name | Radiance Family Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1262 W Amity St, Louisburg, Kansas |
| Authorized Official Name and Position | Kelli Elizabeth Docman (APRN) |
| Authorized Official Contact | 9137475374 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Family Care Llc 16143 Foster St Overland Park KS 66085-8417 Ph: (913) 747-5374 | Radiance Family Care Llc 1262 W Amity St Louisburg KS 66053-7815 Ph: (913) 747-5374 |
| NPI Number | 1396344115 |
|---|---|
| Provider Enumeration Date | 10/22/2020 |
| Last Update Date | 10/22/2020 |
| Medicare PECOS PAC ID | 1355752189 |
|---|---|
| Medicare Enrollment ID | O20201130000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396344115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kelli E Docman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558922583 PECOS PAC ID: 0840525085 Enrollment ID: I20190710003543 |
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