Active NPI
McKenna Boothe, LAT, ATC
- Athletic Trainer
- Draper, UT
National Provider Identifier
1811550718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 10416520-4810
- Practice address
- 12943 S 700 E
Draper, UT 84020-6200 - Phone
- (801) 826-6400
- NPI assigned
- Apr 16, 2019
- Last updated
- Jun 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 10416520-4810 | UT | Primary |
Addresses
Primary practice location
12943 S 700 E
Draper, UT 84020-6200
Mailing address
1032 E Old Dairy Rd
Sandy, UT 84094-7210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10416520-4810 | Other | UT | STATE LICENSE NUMBER |
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 |
|---|---|---|---|
| 10416520-4810 | UT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1811550718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1032 E OLD DAIRY RD",
"city": "SANDY",
"state": "UT",
"postal_code": "840947210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12943 S 700 E",
"city": "DRAPER",
"state": "UT",
"postal_code": "840206200",
"telephone_number": "801-826-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTHE",
"first_name": "MCKENNA",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-16",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "UT",
"license": "10416520-4810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "10416520-4810",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.