Active NPI
Radiant Medical Clinic of East Texas LLC
Doing business as Radience Wound Care
- Gerontology Nurse Practitioner
- Tyler, TX
National Provider Identifier
1285454009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- Legal business name
- RADIANT MEDICAL CLINIC OF EAST TEXAS LLC
- Doing business as
- Radience Wound Care
- Practice address
- 3613 Rock Creek Dr
Tyler, TX 75707-1635 - Phone
- (903) 343-7480
- NPI assigned
- Oct 16, 2024
- Last updated
- Oct 16, 2024
- Organization subpart
- Yes
- Parent organization
- RADIANT MEDICAL CLINIC OF EAST TEXAS LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Doris Udosen, APRN
- Title
- President
- Phone
- (903) 343-7480
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | Primary |
Addresses
Primary practice location
3613 Rock Creek Dr
Tyler, TX 75707-1635
Mailing address
3613 Rock Creek Dr
Tyler, TX 75707-1635
Phone (903) 343-7480
Other names 1
- Radience Wound Care
National Provider Directory
National Provider Directory- Part of
- Radiant Medical Clinic of East Texas LLC
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Acute Care Nurse Practitioner
- Tyler, TX
- NPI 1700369808
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729036800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1729036800000",
"number": "1285454009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3613 ROCK CREEK DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757071635",
"telephone_number": "903-343-7480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3613 ROCK CREEK DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757071635",
"telephone_number": "903-343-7480"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RADIANT MEDICAL CLINIC OF EAST TEXAS LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "RADIANT MEDICAL CLINIC OF EAST TEXAS LLC",
"enumeration_date": "2024-10-16",
"last_updated": "2024-10-16",
"certification_date": "2024-10-15",
"status": "A",
"authorized_official_last_name": "UDOSEN",
"authorized_official_first_name": "DORIS",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "903-343-7480",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "APRN"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Gerontology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Radience Wound Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.