Active NPI
Misty Lynn Boozenny
- Peer Specialist
- Provo, UT
National Provider Identifier
1477027233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 952
- Practice address
- 750 N Freedom Blvd
Provo, UT 84601-1677 - Phone
- (801) 373-4760
- Fax
- (801) 373-0639
- NPI assigned
- Jan 15, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 952 | UT | Primary |
Addresses
Primary practice location
750 N Freedom Blvd
Provo, UT 84601-1677
Mailing address
1338 S 2320 E
Spanish Fork, UT 84660-6419
Phone (801) 979-8105
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 |
|---|---|---|---|
| 952 | UT | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1477027233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1338 S 2320 E",
"city": "SPANISH FORK",
"state": "UT",
"postal_code": "846606419",
"telephone_number": "801-979-8105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 N FREEDOM BLVD",
"city": "PROVO",
"state": "UT",
"postal_code": "846011677",
"telephone_number": "801-373-4760",
"fax_number": "801-373-0639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOZENNY",
"first_name": "MISTY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-15",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "UT",
"license": "952",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.