Healthcare Provider Details

I. General information

NPI: 1366357261
Provider Name (Legal Business Name): KELECHI C ONYIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ROSE ST LEXINGTON KY 40536
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

275 NEW TOWNE DR APT 628
BOWLING GREEN KY
42103-8914
US

V. Phone/Fax

Practice location:
  • Phone: 502-510-6053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: