| Radiant | |
|
2301 Terra Crossing Blvd Ste 103 Louisville KY 40245-4994 | |
| (304) 687-4204 | |
| Not Available |
| Full Name | Radiant |
|---|---|
| Speciality | General Practice |
| Location | 2301 Terra Crossing Blvd, Louisville, Kentucky |
| Authorized Official Name and Position | Tiffany Smith (PRESIDENT) |
| Authorized Official Contact | 3046874204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiant 2301 Terra Crossing Blvd Ste 103 Louisville KY 40245-3909 Ph: (502) 410-0191 | Radiant 2301 Terra Crossing Blvd Ste 103 Louisville KY 40245-4994 Ph: (304) 687-4204 |
| NPI Number | 1831555143 |
|---|---|
| Provider Enumeration Date | 01/04/2016 |
| Last Update Date | 10/03/2022 |
| Medicare PECOS PAC ID | 8426337122 |
|---|---|
| Medicare Enrollment ID | O20161121002292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831555143 | NPI | - | NPPES |
| Provider Name | Cristal Lea Pollak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134555402 PECOS PAC ID: 0547494650 Enrollment ID: I20131003000192 |
| Provider Name | Jennifer L Gondoly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629540711 PECOS PAC ID: 6800127093 Enrollment ID: I20191021001325 |
| Provider Name | Robin A Schmalz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629672928 PECOS PAC ID: 5799198214 Enrollment ID: I20201230001072 |
| Provider Name | Avian Joule Schafer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386246429 PECOS PAC ID: 7618381930 Enrollment ID: I20210128000904 |
| Provider Name | Laura Elizabeth Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144998212 PECOS PAC ID: 1355748534 Enrollment ID: I20210930003098 |
| Provider Name | Amy N Youell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235467481 PECOS PAC ID: 7719012004 Enrollment ID: I20221108002281 |
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