Provider Demographics
NPI:1215562517
Name:SEHRT, CORY ETHEREDGE (PA)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:ETHEREDGE
Last Name:SEHRT
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 S UNION BLVD STE 350
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3146
Practice Address - Country:US
Practice Address - Phone:719-633-5515
Practice Address - Fax:719-471-2258
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2025-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA322254363A00000X
COPA.0008937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant