Active NPI
Dalis Boyette
- Athletic Trainer
- Waco, TX
National Provider Identifier
1649805409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT5667
- Practice address
- 1500 S University Parks Dr
Waco, TX 76706-1731 - Phone
- (254) 405-5856
- NPI assigned
- Mar 11, 2020
- Sex
- Male
- 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 | AT5667 | TX | Primary |
Addresses
Primary practice location
1500 S University Parks Dr
Waco, TX 76706-1731
Mailing address
3100 Beutel Road
Lorena, TX 76655
Phone (979) 587-5930
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | baylor.edu | Direct |
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 |
|---|---|---|---|
| AT5667 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583884800000",
"number": "1649805409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 BEUTEL ROAD",
"city": "LORENA",
"state": "TX",
"postal_code": "76655",
"telephone_number": "979-587-5930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S UNIVERSITY PARKS DR",
"city": "WACO",
"state": "TX",
"postal_code": "767061731",
"telephone_number": "254-405-5856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYETTE",
"first_name": "DALIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-11",
"last_updated": "2020-03-11",
"certification_date": "2020-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT5667",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "baylor.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1500 S University Parks Dr",
"city": "Waco",
"state": "TX",
"country_code": "US",
"postal_code": "767061731",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.