Provider Demographics
NPI:1720616212
Name:ONYX REGENT HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:ONYX REGENT HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:270-779-9408
Mailing Address - Street 1:2459 MOUNT VICTOR LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9061
Mailing Address - Country:US
Mailing Address - Phone:270-935-5234
Mailing Address - Fax:270-935-5173
Practice Address - Street 1:2459 MOUNT VICTOR LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-9061
Practice Address - Country:US
Practice Address - Phone:270-935-5234
Practice Address - Fax:270-935-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty