Healthcare Provider Details

I. General information

NPI: 1700450780
Provider Name (Legal Business Name): BRYNN SKINNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FALCON PKWY
COLORADO SPRINGS CO
80912-5005
US

IV. Provider business mailing address

220 FALCON PKWY
COLORADO SPRINGS CO
80912-5005
US

V. Phone/Fax

Practice location:
  • Phone: 719-567-5536
  • Fax: 719-567-5536
Mailing address:
  • Phone: 719-567-5536
  • Fax: 719-567-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008752
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: