Healthcare Provider Details

I. General information

NPI: 1386200269
Provider Name (Legal Business Name): BPERSONS CRNA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 QUAIL LAKE LOOP STE 220
COLORADO SPRINGS CO
80906-4651
US

IV. Provider business mailing address

5830 EGGAR CT
PEYTON CO
80831-8103
US

V. Phone/Fax

Practice location:
  • Phone: 719-203-6111
  • Fax: 877-247-9218
Mailing address:
  • Phone: 830-832-3395
  • Fax: 719-354-4530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENT JON PERSONS
Title or Position: OWNER
Credential: CRNA
Phone: 830-832-3395