Provider Demographics
NPI:1447373600
Name:MCCORMICK, SHERRY J (NP)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:J
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:J
Other - Last Name:WILDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:720-255-2350
Mailing Address - Fax:720-379-8374
Practice Address - Street 1:9695 S YOSEMITE STE STE 150
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:720-255-2350
Practice Address - Fax:720-379-8374
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO168284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800141Medicare PIN
COQ27727Medicare UPIN