Healthcare Provider Details

I. General information

NPI: 1376479592
Provider Name (Legal Business Name): EMILY BLOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 COTTONWOOD ST
DELTA CO
81416-4400
US

IV. Provider business mailing address

4105 S CIMARRON WAY APT 1224
AURORA CO
80014-4232
US

V. Phone/Fax

Practice location:
  • Phone: 970-399-4200
  • Fax:
Mailing address:
  • Phone: 719-242-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009943
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: