MEDICARE: DR. BRYCE J THACKER DNP, CNS, FNP-C

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0005929-NP	CO
2	363LF0000X	Family Nurse Practitioner	APN.00005929-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386670545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYCE J THACKER DNP, CNS, FNP-C

Provider Business Mailing Address
First Line	:	393 ELDRIDGE ST
Second Line	:
City	:	BURLINGTON
State	:	CO
Zip	:	80807-1356
Country	:	US
Telephone Number	:	719-343-5388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 CENTRAL PARK BLVD UNIT 100
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2300
Country	:	US
Telephone Number	:	833-351-8255
Fax Number	:

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	05/12/2025

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