Active NPI
Minda McCullough-Yray, MS, ATC
- Athletic Trainer
- Corvallis, OR
National Provider Identifier
1194192021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 10169784
- Practice address
- 1754 SW Easy St
Corvallis, OR 97333-1762 - Phone
- (530) 632-2146
- NPI assigned
- Aug 26, 2015
- 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 | 10169784 | OR | Primary |
Addresses
Primary practice location
1754 SW Easy St
Corvallis, OR 97333-1762
Mailing address
1754 SW Easy St
Corvallis, OR 97333-1762
Phone (530) 632-2146
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10169784 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440547200000",
"number": "1194192021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1754 SW EASY ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973331762",
"telephone_number": "530-632-2146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1754 SW EASY ST",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973331762",
"telephone_number": "530-632-2146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH-YRAY",
"first_name": "MINDA",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-26",
"last_updated": "2015-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "10169784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.