Active NPI
Radiah Myrick
- Prevention Professional
- St Petersburg, FL
National Provider Identifier
1093246027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 120806
- Practice address
- 200 78TH Ave N Apt 73
St Petersburg, FL 33702-4466 - Phone
- (727) 712-7661
- NPI assigned
- Mar 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 120806 | FL | |
| Prevention Professional | 405300000X | 120806 | FL | Primary |
Addresses
Primary practice location
200 78TH Ave N Apt 73
St Petersburg, FL 33702-4466
Mailing address
200 78TH Ave N Apt 73
St Petersburg, FL 33702-4466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120806 | FL | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1093246027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 78TH AVE N APT 73",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337024466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 78TH AVE N APT 73",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337024466",
"telephone_number": "727-712-7661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYRICK",
"first_name": "RADIAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-22",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "FL",
"license": "120806",
"primary": false
},
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "FL",
"license": "120806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.