# RADIANT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831555143
- **Authorized official:** MS. TIFFANY SMITH PA-C (PRESIDENT)
- **Authorized official phone:** (304) 687-4204

## Contact information

- **Practice address:** 2301 TERRA CROSSING BLVD, STE 103, LOUISVILLE, KY 40245-4994
- **Practice address phone:** (304) 687-4204
- **Mailing address:** 2301 TERRA CROSSING BLVD STE 103, LOUISVILLE, KY 40245-3909
- **Mailing address phone:** (502) 410-0191
- **Mailing address fax:** (502) 890-5177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 22964 | KY | Yes |
| 363A00000X | Physician Assistant | PA1075 | KY | — |
| 363LF0000X | Family Nurse Practitioner | 3007017 | KY | — |

## Other

- **Enumeration date:** 01/04/2016
- **Last updated:** 10/03/2022