MEDICARE: JOY CORNELIUS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1407657588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOY CORNELIUS

Provider Business Mailing Address
First Line	:	1880 AFFIRMED CIR
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-7635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 AFFIRMED CIR
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-7635
Country	:	US
Telephone Number	:	270-779-9408
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOY CORNELIUS
Credential	:
Telephone Number	:	270-779-9408

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	04/29/2025

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Directions to “JOY CORNELIUS ” Practice Location

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