Provider Demographics
NPI:1851541528
Name:WILKERSON, CORI LYNN (MPA-C)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:LYNN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MPA-C
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:LYNN
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPA-C
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4036
Mailing Address - Fax:970-490-4378
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:IRON HORSE FAMILY MEDICINE CLINIC
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-503-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1084937363A00000X
AL843363A00000X
COPA0004133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I971076OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)- MEDICARE
ALG772OtherGROUP TRANSACTION ACCESS NUMBER (PTAN)