Provider Demographics
NPI:1255008280
Name:FRONTIER FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:FRONTIER FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC, PMHNP
Authorized Official - Phone:888-925-5859
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 1:4598 CR 60
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1356
Practice Address - Country:US
Practice Address - Phone:888-925-5254
Practice Address - Fax:833-784-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty