Individual
CORI LYNN WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPA-C
Contact information
Practice address
1650 COCHRANE CIR, IRON HORSE FAMILY MEDICINE CLINIC, FORT CARSON, CO 80913-4613
(719) 503-7227
Mailing address
2695 ROCKY MOUNTAIN AVE, STE 150, LOVELAND, CO 80538-9071
(970) 624-4036
(970) 490-4378
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1084937
—
363A00000X
Physician Assistant
843
AL
363A00000X
Physician Assistant
Primary
PA0004133
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I971076
PROVIDER TRANSACTION ACCESS NUMBER (PTAN)- MEDICARE
AL
01
—
G772
GROUP TRANSACTION ACCESS NUMBER (PTAN)
AL
Enumeration date
09/30/2008
Last updated
07/27/2016
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