Individual provider Active NPI

Courtney Bryce Thayer

  • Family Nurse Practitioner
  • Burkburnett, TX
National Provider Identifier
1417767302
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1185946 Issued in TX
Practice address
602 Mimosa St
Burkburnett, TX 76354-2350
Phone
(940) 224-3610
NPI assigned
Jan 13, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1185946 TX Primary

Addresses

Primary practice location

602 Mimosa St
Burkburnett, TX 76354-2350

Mailing address

602 Mimosa St
Burkburnett, TX 76354-2350
Phone (940) 224-3610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250323000032 TX Practitioner - Nurse Practitioner 6204358989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wound Navigator Consulting PLLCGroup PAC ID 4284074329, 4 clinicians

Practice addresses (Care Compare)

1518 10TH St
Wichita Falls, TX 76301-4405
Phone (940) 282-9216

Hospital & facility affiliations

  • Angels Care Home Health Home health agency, Wichita Falls, TX, CCN 459298
  • United Regional Health Care System Hospital, Wichita Falls, TX, CCN 450010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1185946TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wound Navigator Consulting PLLC CurrentSince Jan 10, 2025 Accepting new patients
Wound Navigator LLC PastSince Feb 25, 2024 Accepting new patients

Locations

1518 10th St
Wichita Falls, TX 76301
Phone (940) 253-7160

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1417767302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MIMOSA ST",
            "city": "BURKBURNETT",
            "state": "TX",
            "postal_code": "763542350",
            "telephone_number": "940-224-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MIMOSA ST",
            "city": "BURKBURNETT",
            "state": "TX",
            "postal_code": "763542350",
            "telephone_number": "940-224-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAYER",
        "first_name": "COURTNEY",
        "middle_name": "BRYCE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1185946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burkburnett, TX

Sources for this page

Verify at the official NPI Registry.