Active NPI
McKaley Brewer, ATC/R
- Athletic Trainer
- McMinnville, OR
National Provider Identifier
1164831301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-AT-10159451
- Practice address
- 2954 NE Evans St
#60
McMinnville, OR 97128-8267 - Phone
- (206) 898-1164
- NPI assigned
- Aug 12, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT-AT-10159451 | OR | Primary |
| Athletic Trainer | 2255A2300X | A160422220 | WA |
Addresses
Primary practice location
2954 NE Evans St
#60
McMinnville, OR 97128-8267
Mailing address
2954 NE Evans St
#60
McMinnville, OR 97128-8267
Phone (206) 898-1164
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 |
|---|---|---|---|
| AT-AT-10159451 | OR | MD | Athletic Trainer |
| A160422220 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407801600000",
"number": "1164831301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2954 NE EVANS ST",
"address_2": "#60",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971288267",
"telephone_number": "206-898-1164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2954 NE EVANS ST",
"address_2": "#60",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971288267",
"telephone_number": "206-898-1164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREWER",
"first_name": "MCKALEY",
"credential": "ATC/R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-12",
"last_updated": "2014-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "AT-AT-10159451",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A160422220",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.