Radwa Clarissa Omar, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3008054 Issued in KY

Practice address

3602 Cumberland Ave Ste B102
Middlesboro, KY 40965-2614

Phone

(606) 248-7778

Fax

(606) 248-7787

NPI assigned

May 28, 2013

Last updated

Jan 28, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kentucky Friendly Care Center, Inc.

  • Rural Health Clinic/Center
  • Middlesboro, KY
  • NPI 1467939066
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1598102832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2898",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409654898",
            "telephone_number": "606-248-7778",
            "fax_number": "606-248-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3602 CUMBERLAND AVE STE B102",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652614",
            "telephone_number": "606-248-7778",
            "fax_number": "606-248-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMAR",
        "first_name": "RADWA",
        "middle_name": "CLARISSA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-28",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3008054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MM3197527",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Matthew Neverstitch, PHARMD
• Nexus Lab, Inc.
• Nicole Pursifull Family Practitioner
• Holden North, DPT
• Charles I. Okwundu, MD
• Jennifer Erin Owens, DNM, PHD
• Steven W Partin, TCM
• Nitinkumar K Patel, MD
• Amber Craig Peace, DO
• Pediatric Clinic

• Family Nurse Practitioner in Middlesboro, KY
• Providers in Middlesboro, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.