MEDICARE: 3 CORD HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1174482327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3 CORD HEALTH, LLC

Provider Business Mailing Address
First Line	:	1144 LAKE GULCH RD
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-9743
Country	:	US
Telephone Number	:	303-328-1838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 LAKE GULCH RD
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-9743
Country	:	US
Telephone Number	:	303-328-1838
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TY LAMONT SHETTRON
Credential	:	FNP-BC
Telephone Number	:	303-328-1838

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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