MEDICARE: TIERRA ONYX COLE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	1171929	KY

General Provider Information

NPI Number	:	1124986468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERRA ONYX COLE RN

Provider Business Mailing Address
First Line	:	2010 ORIOLE DR
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-5487
Country	:	US
Telephone Number	:	502-956-0643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 E MARKET ST STE 301
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1874
Country	:	US
Telephone Number	:	502-629-3099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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