Provider Demographics
NPI:1972213379
Name:RADIANT HEALTH AND HORMONE THERAPY, PLLC
Entity type:Organization
Organization Name:RADIANT HEALTH AND HORMONE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-254-4335
Mailing Address - Street 1:409 E MEADOWLARK CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1082
Mailing Address - Country:US
Mailing Address - Phone:605-254-4335
Mailing Address - Fax:844-550-1755
Practice Address - Street 1:409 E MEADOWLARK CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1082
Practice Address - Country:US
Practice Address - Phone:605-254-4335
Practice Address - Fax:844-550-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty