Healthcare Provider Details

I. General information

NPI: 1861746158
Provider Name (Legal Business Name): KORY LYNN EHRENFRIED PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KORY LYNN BOEING PA-C

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MERCY HEALTH BLVD
CINCINNATI OH
45211-1103
US

IV. Provider business mailing address

3300 MERCY HEALTH BLVD
CINCINNATI OH
45211-1103
US

V. Phone/Fax

Practice location:
  • Phone: 513-215-5000
  • Fax:
Mailing address:
  • Phone: 513-215-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1777
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC159
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: