JACK LESLIE KELLEY MD NPI 1710956065

NPI Information

  • NPI: 1710956065
  • Provider Name: JACK LESLIE KELLEY, MD
  • Classification: Surgery - 208600000X
  • Entity Type: Individual
  • Address: 1500 SALEM ST
    LAFAYETTE, IN
    ZIP 47904
  • Phone: (765) 448-8000

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NPI Details

Jack Leslie Kelley, MD is a surgery in Lafayette, IN. The provider is 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. Jack Leslie Kelley, MD NPI is 1710956065. 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:

1500 SALEM ST
LAFAYETTE, IN
ZIP 47904-164
Phone: (765) 448-8000
Fax: (765) 448-8337

The enumeration date for this NPI number is 3/17/2006 and was last updated on 7/23/2012.

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
1208600000XSurgery01022437AINDIANAYes

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
110825369OTHERINDIANACAQH NUMBER
2815500BBMEDICARE PININDIANA
3100230510MEDICAIDINDIANA
4KE80251002MEDICAIDINDIANA
5000000197818OTHERINDIANAANTHEM PROVIDER NUMBER
69017025OTHERINDIANAPHCS PID NUMBER
7815490NNNMEDICARE PININDIANA
8E03840MEDICARE UPININDIANA
9020038425MEDICARE PININDIANA

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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