Kelly, John B

Kelly, John B is an individual health care provider with primary practice located at 3505 E Meridian Park Loop Ste 100 , Wasilla AK 99654-7242. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Kelly, John B can be contacted via phone (907) 864-0022.

Contact Information

Primary practice address
3505 E Meridian Park Loop Ste 100 Wasilla AK 99654-7242
Phone: (907) 864-0022
Fax: (877) 725-7371
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 27953 Kentucky
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 27953 Kentucky
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 203883 Alaska

Profile Details

NPI number 1407855315
LBN Legal business name Kelly, John B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2005
Last updated Oct 11th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407855315 NPPES
Alaska MEDICAID 1740353

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