Provider Demographics
NPI:1386670545
Name:THACKER, BRYCE J (DNP, CNS, FNP-C)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:J
Last Name:THACKER
Suffix:
Gender:
Credentials:DNP, CNS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 ELDRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1356
Mailing Address - Country:US
Mailing Address - Phone:719-343-5388
Mailing Address - Fax:
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.00005929-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731708Medicaid
NE47068731777Medicaid
CO71638741Medicaid
IA0495796Medicaid
IA1495796Medicaid
CO71638741Medicaid
IA0495796Medicaid