JERRY KELLY NPI 1043611783

NPI Information

  • NPI: 1043611783
  • Provider Name: JERRY KELLY
  • Classification: Military Health Care Provider - 171000000X
  • Entity Type: Individual
  • Address: 1061 HARMON AVE
    FORT STEWART, GA
    ZIP 31314
  • Phone: (912) 435-5211

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NPI Details

Jerry Kelly is a military health care provider in Fort Stewart, GA. The provider is active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. Jerry Kelly NPI is 1043611783. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1061 HARMON AVE
FORT STEWART, GA
ZIP 31314-641
Phone: (912) 435-5211

The enumeration date for this NPI number is 9/12/2014 and was last updated on 9/12/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1171000000XMilitary Health Care ProviderE3038628Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E3038628OTHERNREMT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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