Active NPI
McKenley Boam, ATC
- Athletic Trainer
- Provo, UT
National Provider Identifier
1629865639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 425914
- Practice address
- 1227 Riverside Ave Apt 60
Provo, UT 84604-3288 - Phone
- (713) 330-9308
- NPI assigned
- Apr 22, 2025
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 425914 | UT | Primary |
Addresses
Primary practice location
1227 Riverside Ave Apt 60
Provo, UT 84604-3288
Mailing address
1227 Riverside Ave Apt 60
Provo, UT 84604-3288
Phone (713) 330-9308
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 |
|---|---|---|---|
| 425914 | UT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745280000000",
"number": "1629865639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1227 RIVERSIDE AVE APT 60",
"city": "PROVO",
"state": "UT",
"postal_code": "846043288",
"telephone_number": "713-330-9308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1227 RIVERSIDE AVE APT 60",
"city": "PROVO",
"state": "UT",
"postal_code": "846043288",
"telephone_number": "713-330-9308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOAM",
"first_name": "MCKENLEY",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-22",
"last_updated": "2025-04-22",
"certification_date": "2025-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "UT",
"license": "425914",
"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 Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.