MR. BRADLEY PHILIP COUGHLIN (NPI# 1053399451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053399451 |
| Entity Type | Individual |
| Full Name | MR. BRADLEY PHILIP COUGHLIN |
| Credential | PA-C |
| Practice Address |
2767 Janitell Rd Colorado Springs CO 80906-4102 |
| Mailing Address |
1650 Cochrane Cir Bldg 7505 Credentials Office Rm # 163 Colorado Springs CO 80913-4613 |
| Practice Telephone | 7193652888 |
| Mailing Telephone | 7195262092 |
| Mailing Fax Number | 7195267732 |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2020-05-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
2850 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
0110002173 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | RAILROAD MEDICARE | P00306338 | 01 |
| VA | JOHN DEERE HEALTH | TN0141 | 01 |
| VA | 010213355 | 05 |
| Street Address |
2767 JANITELL RD |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80906-4102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023006996 | Renee A. Barall | Nurse Practitioner | 2767 Janitell Rd, Colorado Springs, Colorado Springs, CO 80906-4102 | 2005-10-13 |
| 1942815246 | Poudre Valley Medical Group, LLC | Clinic/Center | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2020-09-14 |
| 1912476292 | Nathan Douglas Bennion | Physician Assistant | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2018-11-16 |
| 1184132771 | Amanda Lee Bishop | Nurse Practitioner | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2018-01-17 |
| 1235647066 | Jodi Marie Killilea | Registered Nurse | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2018-01-15 |
| 1255859526 | James Bradley Hsueh | Physician Assistant | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2017-09-06 |
| 1295250983 | Robert Edward Graves | Nurse Practitioner | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2017-08-03 |
| 1811432099 | Sarah Praner | Nurse Practitioner | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2016-12-27 |
| 1710357462 | Amber Gates | Nurse Practitioner | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2015-10-06 |
| 1104295195 | Keri Griffith | Nurse Practitioner | 2767 Janitell Rd, Colorado Springs, CO 80906-4102 | 2015-09-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437797339 | Michael Crise | Behavior Technician | 1330 Qual Lake Loop Ste 120, Colorado Springs, CO 80906 | 2019-12-11 |
| 1730720541 | Amanda Salinas | Massage Therapist | 1235 Lake Plaza Drive Suite 230, Colorado Springs, CO 80906 | 2019-10-02 |
| 1225511488 | Sheila Meggison | Massage Therapist | 1235 Lake Plaza Drive, Suite 230, Colorado Springs, CA 80906 | 2018-09-12 |
| 1316429756 | Vivus Counseling Services LLC | Counselor | 108 East Cheyenne Rd Suite 201, Colorado Springs, CO 80906 | 2018-09-01 |
| 1043796949 | Erin Lee Recinos | Nurse Practitioner | 225 E Cheyenne Mountain Blvd Ste 220, Colorado Springs, CO 80906 | 2018-07-13 |
| 1982103875 | Savannah Adeline Rentrop | Behavior Technician | 2989 Broadmoor Valley Rd D, Colorado Springs, CO 80906 | 2018-02-06 |
| 1205335288 | Ross Knowlton | Behavior Technician | 1330 Quail Lake Loop Suite 200, Colorado Springs, CO 80906 | 2018-02-06 |
| 1942709845 | Adrienne Bohlen | Behavior Technician | 1330 Quail Lake Loop, Ste. 200, Colorado Springs, CO 80906 | 2018-02-06 |
| 1881110088 | Christine Gonzales | Nurse Practitioner | 2739 E Las Vegas St, Colorado Springs, CO 80906 | 2017-08-18 |
| 1225568470 | Larry Alwine | Counselor | 2860 South Circle Drive, Unit 250k, Colorado Springs, CO 80906 | 2017-06-19 |
| Find all providers in zip 80906 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851726681 | Lisa Kay Adams | Physician Assistant | 525 N Foote Ave Ste 202, Colorado Springs, CO 80909-4501 | 2013-09-11 |
| 1992945208 | Susan Gardiner Cump | Physician Assistant | 2940n Circle Dr, Colorado Springs, CO 80909-1160 | 2009-02-26 |
| 1356591762 | Johnathon D. Kupfner | Physician Assistant | 1584 Jackson Creek Parkway, Ste 120, Colorado Springs, CO 80132 | 2008-09-22 |
| 1427218916 | Gary Patrick Tocci | Physician Assistant | 9310 Sky King Dr, Colorado Springs, CO 80924-2020 | 2008-06-10 |
| 1619144888 | Laurie K Redding | Physician Assistant | 2130 Hollow Brook Dr, Suite 100, Colorado Springs, CO 80918-8400 | 2008-05-15 |
| 1760520746 | Donald Ray Lawson | Physician Assistant | 7667 Steward Ln, Colorado Springs, CO 80922-6327 | 2007-02-02 |
| 1245321140 | Kim Redinger | Physician Assistant | 1740 Pepperwood Dr, Colorado Springs, CO 80910-1525 | 2006-09-27 |
| 1366452401 | Kenneth L Phillips Jr. | Physician Assistant | 15026 La Jolla Pl, Colorado Springs, CO 80921-2564 | 2006-08-09 |
| 1770538159 | Jane D Brockhausen | Physician Assistant | 5799 Stetson Hills Blvd Ste 100, Colorado Springs, CO 80917-4223 | 2006-05-23 |
| 1033173851 | Michael E Young | Physician Assistant | 2222 N Nevada Ave Ste 5011, Colorado Springs, CO 80907-6819 | 2006-04-17 |
| Find all providers in COLORADO SPRINGS | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80906 |
Please comment or provide details below to improve the information on MR. BRADLEY PHILIP COUGHLIN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.