Keegan Nichols, MS, ATC, SPT

NPI 1265802631 · on the registry since 2015

Practice

Address: 554 N Steelhead Way Ste 162
Boise, ID 83704
Phone: (208) 323-9747
Fax: (208) 323-9752
Organisation at this address: Blair Legacy, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 5

Registry record

Primary taxonomy: 225100000X
225100000X
Also registered as: 390200000X
Licence states on file: ID
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2021-08-17

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho