McKinley Boatner, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

578 Issued in OK

Practice address

1901 Springlake Dr
Oklahoma City, OK 73111-5201

Phone

(405) 521-8486

Fax

(405) 521-8496

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: mboatner@chciokc.directbygreenway.com

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1508840695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30589",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731403589",
            "telephone_number": "405-769-3301",
            "fax_number": "405-769-9685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 SPRINGLAKE DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731115201",
            "telephone_number": "405-521-8486",
            "fax_number": "405-521-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOATNER",
        "first_name": "MCKINLEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "578",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "578",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200013400A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200013400B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200013400C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Board of Regents of the University of Oklahoma-Ou Physicians
• Board of Regents of the University of Oklahoma, Health Sciences Center (College of Dentistry Student Clinics)
• Board of Regents University of Oklahoma College of Dentistry
• Board of Rengents of the Univ of Oklahoma - Ou Phys Breast Institute
• Jalisha Boatman
• Sean McKinley Boatner Sr.
• Jay Saunders Bobb, DO
• Bobby Moore DPT, PLLC (Sideout Sports Physical Therapy)
• Bobby R Jacobs MD PC
• Toni Bobek

• Medical Physician Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.

Verify at the official NPI Registry.