Provider Demographics
NPI:1386200269
Name:BPERSONS CRNA PLLC
Entity type:Organization
Organization Name:BPERSONS CRNA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:PERSONS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:830-832-3395
Mailing Address - Street 1:5830 EGGAR CT
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8103
Mailing Address - Country:US
Mailing Address - Phone:830-832-3395
Mailing Address - Fax:719-354-4530
Practice Address - Street 1:1330 QUAIL LAKE LOOP STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-203-6111
Practice Address - Fax:877-247-9218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BPERSONS CRNA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARNP-D139177OtherADVANCED REGISTERED NURSE PRACTIONER
IAD139177OtherIOWA BOARD OF NURSING