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KELLER SKIN CARE
NPI 1649543323
Dermatology in Eagle, ID

Active since February 11, 2012CLIA 13D1084738 · Certificate of Compliance
1605 E RIVERSIDE DRIVE, EAGLE, ID 83616(208) 939-6227(208) 939-6442 Get Directions Write a Review

NPPES record last updated: November 3, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 3, 2022, Jul 21, 2022, Feb 12, 2020 and 3 more (6 updates tracked since 2017).

About Keller Skin Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLER SKIN CARE (NPI 1649543323) is a healthcare organization registered as a dermatology in Eagle, Idaho and active in the NPI registry since February 2012. The organization holds a CLIA Certificate of Compliance certificate valid through January 4, 2028 and lists Wade Robert Keller, President, as its authorized official.

NPPES Registry Identity

NPI1649543323
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameKELLER SKIN & CANCER CARE PC
Location Address1605 E RIVERSIDE DRIVEEagle, ID 83616
Mailing Address1605 E Riverside DrEagle, ID 83616-6237 · (208) 939-6227 · Fax (208) 939-6442
Phone(208) 939-6227
Fax(208) 939-6442
Organization SubpartNo
Authorized OfficialWade Robert KellerPresident · (208) 939-6227
Enumeration DateFebruary 11, 2012
Last NPPES UpdateNovember 3, 20226 updates tracked since enumeration
NPPES CertifiedNovember 3, 2022
✔ NPI 1649543323 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in ID · O-0559
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
1605 E RIVERSIDE DRIVE, Eagle, ID 83616
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Other Names 1

Doing Business AsKeller Skin Care

Group Practice 2

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 13D1084738

Keller Skin & Cancer Care, PC · Eagle, ID
Active · expires Jan 4, 2028
CLIA Number13D1084738
Laboratory TypePractitioner Other
Certificate Effective DateJanuary 5, 2026
Certificate Expiration DateJanuary 4, 2028
Laboratory DirectorWade R. Keller
Laboratory Phone(208) 939-6227
Laboratory LocationKeller Skin & Cancer Care, PC1605 E Riverside Dr, Eagle, ID 83616
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEATHER NICOLE KNUTSON N.P.
Dermatology
1605 E RIVERSIDE DRIVE
EAGLE, ID 83616
Ada County (208) 939-6227
ANGELA ANN COYNE PA
Physician Assistant (Medical)
1605 E RIVERSIDE DRIVE
EAGLE, ID 83616
Ada County (208) 939-6227

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keller Skin & Cancer Care PC's NPI number?

The NPI number for Keller Skin & Cancer Care PC is 1649543323. It was assigned to this organization in the NPPES registry on February 11, 2012. The provider is doing business as Keller Skin Care.

Where is Keller Skin & Cancer Care PC located?

Keller Skin & Cancer Care PC is located at 1605 E Riverside Drive, Eagle, ID 83616. The listed phone number is (208) 939-6227.

What is Keller Skin & Cancer Care PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Keller Skin & Cancer Care PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 13D1084738) is associated with this NPI, valid through January 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Keller Skin & Cancer Care PC accept?

Health plans from Moda Health Plan, Inc. list Keller Skin & Cancer Care PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Keller Skin & Cancer Care PC was last updated on November 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.