Trevor William Brackney

Primary specialty

Integrative Medicine PhysicianTaxonomy code 202D00000X

License

8180148-8900 Issued in UT

Practice address

3650 N University Ave Ste 200
Provo, UT 84604-6658

Phone

(801) 375-7100

NPI assigned

May 15, 2023

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 18, 2024 through Mar 18, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrative Medical Associates

  • Family Medicine Physician
  • Provo, UT
  • NPI 1144453739
  NPD (past)

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1518658384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 N UNIVERSITY AVE STE 200",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046658",
            "telephone_number": "801-375-7100",
            "fax_number": "801-375-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 N UNIVERSITY AVE STE 200",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046658",
            "telephone_number": "801-375-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKNEY",
        "first_name": "TREVOR",
        "middle_name": "WILLIAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-15",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202D00000X",
            "taxonomy_group": "",
            "desc": "Integrative Medicine",
            "state": "UT",
            "license": "8180148-8900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Boyack, NP
• Kimberly Marie Boykin
• Craig Dennis Boyle, MSW, CSWI
• Jonpaul C Boyle, LCSW
• Abigail Lynn Boyles
• Kimberly Bradfield
• Brooke Bradford
• Christopher Andrew Bradford
• Madisson Bradford, LCSW
• Rachel Bradford

• Integrative Medicine Physician in Provo, UT
• Providers in Provo, UT by specialty
• Integrative Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.