Individual
COREY LYNN ERNST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
2003 BLUEGRASS CIRCLE, CHEYENNE, WY 82009
(307) 634-4357
(307) 634-7773
Mailing address
1110 CRESCENT DR, CHEYENNE, WY 82007-9107
(307) 630-2973
(307) 638-0394
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
187
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116713800
—
WY
01
—
187
STATE LICENSE
WY
01
—
314332
BLUE CROSS BLUE SHIELD
WY
01
—
41CLE01
SUBSTANCE CONTROL
WY
Enumeration date
11/23/2005
Last updated
10/02/2007
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