Healthcare Provider Details

I. General information

NPI: 1902764905
Provider Name (Legal Business Name): BRIAN COE JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E ROUTT AVE
PUEBLO CO
81004-2117
US

IV. Provider business mailing address

2302 CHIMAYO DR
COLORADO SPRINGS CO
80911-1010
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-8711
  • Fax:
Mailing address:
  • Phone: 719-229-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001504-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: