MEDICARE: BRENDAN PHELPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1275286379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDAN PHELPS

Provider Business Mailing Address
First Line	:	4695 CENTAURI RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3115
Country	:	US
Telephone Number	:	813-774-0947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1861 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-7868
Country	:	US
Telephone Number	:	719-419-7735
Fax Number	:	970-639-4475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	02/16/2026

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Directions to “ BRENDAN PHELPS ” Practice Location

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