MEDICARE: ONYX HEALTH & WELLNESS, LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1811686116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONYX HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 52
Second Line	:
City	:	SPENCER
State	:	OK
Zip	:	73084-0052
Country	:	US
Telephone Number	:	405-314-4451
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 E RENO AVE STE D
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-2119
Country	:	US
Telephone Number	:	405-455-3008
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	ANATAYA RUCKER
Credential	:	APRN,DNP
Telephone Number	:	405-314-4451

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	01/21/2024

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