Provider Demographics
NPI:1942283635
Name:CORNELIUS, JOY DENISE (APRN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:DENISE
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:DENISE
Other - Last Name:CORNELIUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, PMHNP
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003875363LP0808X
KY3875P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009412Medicaid
KYP62796Medicare UPIN
KY78009412Medicaid