Provider Demographics
NPI:1619662582
Name:BRYANT, RAEGAN BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:RAEGAN
Middle Name:BROOKE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 PINE VALLEY VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7816
Mailing Address - Country:US
Mailing Address - Phone:907-830-9905
Mailing Address - Fax:
Practice Address - Street 1:5799 STETSON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4223
Practice Address - Country:US
Practice Address - Phone:719-471-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998588-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily