Active NPI
Breann Michele Booher, ATC
- Athletic Trainer
- Mead, WA
National Provider Identifier
1104227164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A160510329
- Practice address
- 6015 E Mt Spokane Park Dr
Mead, WA 99021-9468 - Phone
- (509) 465-7254
- NPI assigned
- Sep 9, 2014
- Last updated
- Jul 31, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | A160510329 | WA | Primary |
Addresses
Primary practice location
6015 E Mt Spokane Park Dr
Mead, WA 99021-9468
Mailing address
6015 E Mt Spokane Park Dr
Mead, WA 99021-9468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A160510329 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501459200000",
"number": "1104227164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6015 E MT SPOKANE PARK DR",
"city": "MEAD",
"state": "WA",
"postal_code": "990219468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6015 E MT SPOKANE PARK DR",
"city": "MEAD",
"state": "WA",
"postal_code": "990219468",
"telephone_number": "509-465-7254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOHER",
"first_name": "BREANN",
"middle_name": "MICHELE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-09",
"last_updated": "2017-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A160510329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mead, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.