Christine E Cork, PA-C CAQ PSYCH

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.0005295 Issued in CO

Practice address

635 Gooseberry Dr Unit 1905
Longmont, CO 80503-6457

Phone

(678) 697-9665

NPI assigned

Dec 20, 2017

Last updated

Feb 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinica Campesina Family Health Services

  dba Clinica Family Health

  • Clinic/Center
  • Lafayette, CO
  • NPI 1225025406
  Medicare reassignment NPD
• Connections Psychiatry LLC

  • Psychiatry Physician
  • Longmont, CO
  • NPI 1447028394
  NPD Authorized official
• Clinica Campesina Family Health Services

  dba Clinica Family Health and Wellness

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boulder, CO
  • NPI 1477390433
  NPD
• Clinica Campesina Family Health Services

  dba Clinica Family Health and Wellness

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Longmont, CO
  • NPI 1558109223
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1811403363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 GOOSEBERRY DR UNIT 1905",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805036457",
            "telephone_number": "678-697-9665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 GOOSEBERRY DR UNIT 1905",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805036457",
            "telephone_number": "678-697-9665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1455 Dixon Ave",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "CO",
            "postal_code": "800268879",
            "country_code": "US",
            "telephone_number": "303-443-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORK",
        "first_name": "CHRISTINE",
        "middle_name": "E",
        "credential": "PA-C CAQ PSYCH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-20",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0005295",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "PA.0005295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William P Cooney, MD
• Paul L. Cooper, M.D.
• Myles Nathaniel Cope, M.D.
• Megan Theresa Corcoran, LPCC
• Lyndsey Renee Cordova, LAC
• Eve Cornell, MD, DDS
• Cornerstone Caregiving West LLC
• Brian Cortez
• Costco Wholesale Corporation (Costco Pharmacy #1628)
• Costco Wholesale Corporation (Costco Hearing Aid #1628)

• Physician Assistant in Longmont, CO
• Providers in Longmont, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.