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General NPI Number Information
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NPI Number | 1619662582
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Entity Type | Individual
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Provider Name | RAEGAN BROOKE BRYANT NP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 6071 E WOODMEN RD STE 320
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-2612
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Country | US
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Telephone | 719-900-5988
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Fax | 719-212-1793
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Provider Business Mailing Address
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Address Line | 6071 E WOODMEN RD STE 320
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-2612
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Country | US
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Telephone | 719-900-5988
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Fax | 719-212-1793
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0998588-NP
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License Number State | CO
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