Provider Demographics
NPI:1629025168
Name:FRERICHS, CORI M (PA-C)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:M
Last Name:FRERICHS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:M
Other - Last Name:GEHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-330
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-607-9797
Mailing Address - Fax:251-607-9761
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D-330
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-607-9797
Practice Address - Fax:251-607-9761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-26372OtherBLUE CROSS BLUE SHIELD
AL515-26372OtherBLUE CROSS BLUE SHIELD