Individual
RADWA CLARISSA OMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3602 CUMBERLAND AVE STE B102, MIDDLESBORO, KY 40965-2614
(606) 248-7778
(606) 248-7787
Mailing address
PO BOX 2898, MIDDLESBORO, KY 40965-4898
(606) 248-7778
(606) 248-7787
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3008054
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MM3197527
—
KY
Enumeration date
05/28/2013
Last updated
01/28/2020
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