Keith Nichols
Individual provider Active NPI Intermediate Emergency Medical Technician · Moffett Field, CA
NPI 1588511786 · NPPES record last updated Mar 16, 2026
Key facts
- NPI
- 1588511786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intermediate Emergency Medical Technician 146M00000X
- License
- A2058105
- Practice address
- 680 Macon Rd
Moffett Field, CA 94035-1005 - Phone
- (253) 266-3622
- NPI assigned
- Mar 16, 2026
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intermediate Emergency Medical Technician | 146M00000X | A2058105 | Yes |
Addresses
Primary practice location
680 Macon Rd
Moffett Field, CA 94035-1005
Mailing address
680 Macon Rd
Moffett Field, CA 94035-1005
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.