MEDICARE: EMILY ALLEN OWEN

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	363A00000X	Physician Assistant	0009201	CO

General Provider Information

NPI Number	:	1457236499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ALLEN OWEN

Provider Business Mailing Address
First Line	:	400 E PIKES PEAK AVE APT 419
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4276
Country	:	US
Telephone Number	:	713-819-4451
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E PIKES PEAK AVE APT 419
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4276
Country	:	US
Telephone Number	:	713-819-4451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	08/25/2025

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