Keaton James Rider

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

License

L5ALJ4N051C00AB Issued in TX

Practice address

104 W D.L. Ingram Ave
Cannon Afb, NM 88101

Phone

(575) 784-2778

NPI assigned

Feb 18, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1083369938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6948 CAMPOS AVE UNIT B",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995063423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W D.L. INGRAM AVE",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88101",
            "telephone_number": "575-784-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "KEATON",
        "middle_name": "JAMES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-08-02",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": "TX",
            "license": "L5ALJ4N051C00AB",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Lynn Post, P.A.
• Jessica Marie Pothast, PHARMD
• Jordan Ramil, LCSW
• Michael Alonso Ramirez, MD
• Veronica Ruth Revell, RN
• Kenneth Rivera, PHYSICIAN ASSISTANT
• Emma Robertson, DO
• Matthew R Rook
• Joketha Faith Ross, RN-BSN
• Danielle Markeeta Sales, DNP, APRN, WHNP-BC

• Independent Duty Medical Technicians in Cannon Afb, NM
• Providers in Cannon Afb, NM by specialty
• Independent Duty Medical Technicians in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.