Healthcare Provider Details

I. General information

NPI: 1992626105
Provider Name (Legal Business Name): EMMA ANN BRINKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

899 E INDUSTRIAL BLVD
PUEBLO WEST CO
81007-1442
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4000
  • Fax:
Mailing address:
  • Phone: 719-584-4306
  • Fax: 719-595-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009997
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: