Healthcare Provider Details

I. General information

NPI: 1124986468
Provider Name (Legal Business Name): TIERRA ONYX COLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIERRA ONYX EVERSLEY RN

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E MARKET ST STE 301
LOUISVILLE KY
40206-1874
US

IV. Provider business mailing address

2010 ORIOLE DR
ELIZABETHTOWN KY
42701-5487
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-3099
  • Fax:
Mailing address:
  • Phone: 502-956-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1171929
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: