Provider Demographics
NPI:1093606378
Name:RADIANT HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:RADIANT HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:MUMBI
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:434-404-4728
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-0123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:508 7TH STREET
Practice Address - Street 2:OFFICE #111
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517
Practice Address - Country:US
Practice Address - Phone:434-404-4728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care