Healthcare Provider Details

I. General information

NPI: 1023820909
Provider Name (Legal Business Name): AMBER KECK APRN - CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S WOODRUFF AVE STE 4
IDAHO FALLS ID
83404-6371
US

IV. Provider business mailing address

2001 S WOODRUFF AVE STE 4
IDAHO FALLS ID
83404-6371
US

V. Phone/Fax

Practice location:
  • Phone: 208-419-3271
  • Fax: 833-449-4588
Mailing address:
  • Phone: 208-419-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7571644
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: