JACK LESLIE KELLEY MD
NPI 1710956065
Surgery in Lafayette, IN

Q: What is Jack Kelley's NPI number?

The NPI number for Jack Kelley is 1710956065. It was assigned to this individual provider in the NPPES registry on March 17, 2006.

Q: What is Jack Kelley's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Kelley was last updated on July 23, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since March 17, 2006

1500 SALEM ST, LAFAYETTE, IN 47904(765) 448-8000(765) 448-8337 Get Directions Write a Review

NPPES record last updated: July 23, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jack Leslie Kelley Md NPPES

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

JACK LESLIE KELLEY MD (NPI 1710956065) is an individual surgery provider in Lafayette, Indiana, licensed in Indiana (01022437A) and active in the NPI registry since March 2006.

NPPES Registry Identity

NPI1710956065

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameJACK LESLIE KELLEYCredential: MD

Location Address1500 SALEM STLafayette, IN 47904-2164

Mailing AddressPo Box 5545Lafayette, IN 47903-5545 · (765) 448-8000

Phone(765) 448-8000

Fax(765) 448-8337

Sole ProprietorNo

Enumeration DateMarch 17, 2006

Last NPPES UpdateJuly 23, 2012

✔ NPI 1710956065 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in IN · 01022437A

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

1500 SALEM ST, Lafayette, IN 47904

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Other Identifiers 9

Other10825369IN · Caqh Number

Medicare PIN815500BBIN

Medicaid100230510IN

MedicaidKE80251002IN

Other000000197818IN · Anthem Provider Number

Other9017025IN · Phcs Pid Number

Medicare PIN815490NNNIN

Medicare UPINE03840IN

Medicare PIN020038425IN

Other Providers at the Same Location NPPES 20

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

GARY P DILLON MD

Dermatology (Dermatopathology)