Individual
KEATON NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
140 E BOISE AVE, BOISE, ID 83706-4302
(208) 385-9228
Mailing address
140 E BOISE AVE, BOISE, ID 83706-4302
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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