Provider Demographics
NPI:1891681573
Name:WRIGHT, BRYCE (PA)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 W 28TH AVE APT 141
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4437
Mailing Address - Country:US
Mailing Address - Phone:316-644-2542
Mailing Address - Fax:
Practice Address - Street 1:5387 MANHATTAN CIR STE 100B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4283
Practice Address - Country:US
Practice Address - Phone:303-494-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0009260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant