Provider Demographics
NPI:1861746158
Name:EHRENFRIED, KORY LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KORY
Middle Name:LYNN
Last Name:EHRENFRIED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KORY
Other - Middle Name:LYNN
Other - Last Name:BOEING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3300 MERCY HEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1103
Mailing Address - Country:US
Mailing Address - Phone:513-215-5000
Mailing Address - Fax:
Practice Address - Street 1:3300 MERCY HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1103
Practice Address - Country:US
Practice Address - Phone:513-215-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1777363A00000X
KYTC159363A00000X
OH50.003976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076822Medicaid
KY7100230540Medicaid
KY7100230540Medicaid
KYK066880Medicare PIN