MEDICARE: RAEGAN BROOKE BRYANT NP

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	363LF0000X	Family Nurse Practitioner	APN.0998588-NP	CO

General Provider Information

NPI Number	:	1619662582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAEGAN BROOKE BRYANT NP

Provider Business Mailing Address
First Line	:	6071 E WOODMEN RD STE 320
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2612
Country	:	US
Telephone Number	:	719-900-5988
Fax Number	:	719-212-1793

Provider Business Practice Location Address
First Line	:	6071 E WOODMEN RD STE 320
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2612
Country	:	US
Telephone Number	:	719-900-5988
Fax Number	:	719-212-1793

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/18/2025

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