JACK LESLIE KELLEY (NPI# 1710956065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710956065 |
| Entity Type | Individual |
| Full Name | JACK LESLIE KELLEY |
| Credential | MD |
| Practice Address |
1500 Salem St Lafayette IN 47904-2164 |
| Mailing Address |
Po Box 5545 Lafayette IN 47903-5545 |
| Practice Telephone | 7654488000 |
| Practice Fax Number | 7654488337 |
| Mailing Telephone | 7654488000 |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2012-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 01022437A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100230510 | 05 | |
| IN | PHCS PID NUMBER | 9017025 | 01 |
| IN | KE80251002 | 05 | |
| IN | CAQH NUMBER | 10825369 | 01 |
| IN | ANTHEM PROVIDER NUMBER | 000000197818 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437628781 | Jack Steven Kelley | Case Manager/Care Coordinator | 3737 Marconi Ave, Sacramento, CA 95821-5303 | 2018-11-15 |
| 1265873343 | Jack Douglas Kelley | Counselor | 1027 E Burnside St, Portland, OR 97214-1328 | 2013-07-17 |
| 1417030461 | Jack Kelley | Counselor | 607 Hammond Plz, Hopkinsville, KY 42240-4971 | 2006-10-23 |
| Street Address |
1500 SALEM ST |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47904-2164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568448876 | Tamara Loewen Hazbun | Emergency Medicine | 1500 Salem St, Lafayette, IN 47904-2164 | 2005-12-19 |
| 1801246467 | Jacqulyn Burgess | Registered Nurse | 1500 Salem St, Lafayette, IN 47904-2164 | 2016-06-15 |
| 1942656186 | Amanda Dehne | Registered Nurse | 1500 Salem St, Lafayette, IN 47904-2164 | 2016-05-06 |
| 1134527807 | Rebecca J Hauck | Registered Nurse | 1500 Salem St, Lafayette, IN 47904-2164 | 2014-12-12 |
| 1679977128 | Michael E Criswell | Clinical Nurse Specialist | 1500 Salem St, Lafayette, IN 47904-2164 | 2014-10-13 |
| 1962840785 | Amy Sue Mclaughlin | Registered Nurse | 1500 Salem St, Lafayette, IN 47904-2164 | 2013-06-14 |
| 1487920310 | Laurie L Lebegue | Specialist/Technologist, Other | 1500 Salem St, Lafayette, IN 47904-2164 | 2012-03-26 |
| 1356659403 | Leslie Anne Bentinganan | Family Medicine | 1500 Salem St, Lafayette, IN 47904-2164 | 2010-09-22 |
| 1154598563 | Tasbirul Islam | Internal Medicine | 1500 Salem St, Lafayette, IN 47904-2164 | 2008-05-14 |
| 1346413713 | Leslie E Harshman | Specialist/Technologist, Other | 1500 Salem St, Lafayette, IN 47904-2164 | 2008-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568998615 | Angela Hands | Physical Therapy Assistant | 1260 North 17th Street, Lafayette, IN 47904 | 2017-05-11 |
| 1366894164 | Kathryn Barnett | Behavioral Analyst | 2785 Cason St # 2, Lafayette, IN 47904 | 2016-07-06 |
| 1881972917 | Rest Assured, LLC | Durable Medical Equipment & Medical Supplies | 180 Professional Ct., Lafayette, IN 47904 | 2011-07-22 |
| 1144514233 | Michelle Cristin Singleton | Dietitian, Registered | 508 N 26th St, Lafayette, IN 47904 | 2011-06-06 |
| 1912134438 | Jean D Trammel | Marriage & Family Therapist | 2000 Greenburg St, Bldg B, Suite A, Lafayette, IN 47904 | 2009-06-11 |
| 1902946056 | Terry Richard Baker | Optometrist | 2300 Sagamore Parkway S, Lafayette, IN 47904 | 2007-02-07 |
| 1891862165 | Becki A Bowditch Inc | Social Worker | 2201 Ferry Street, Lafayette, IN 47904 | 2006-11-29 |
| 1326121849 | James Lowell Thomas | Pediatrics | 2300 Ferry St, Lafayette, IN 47904 | 2006-10-21 |
| 1700976719 | Michael Leonard Bagnoli | Dentist | 2020 Union Street, Suite 200, Lafayette, IN 47904 | 2006-10-13 |
| 1255428801 | Lynn Arlen Pestle | Dentist | 2550 Elmwood Avenue, Lafayette, IN 47904 | 2006-10-06 |
| Find all providers in zip 47904 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477922904 | Lafayette Health Ventures, Inc. | Surgery | 121 Audubon Blvd, Lafayette, LA 70503-2606 | 2015-09-15 |
| 1164805719 | Lafayette Health Ventures, Inc. | Surgery | 900 E Saint Mary Blvd, Suite 106, Lafayette, LA 70503-2377 | 2015-07-01 |
| 1043595804 | Surgical Hospital Management System LLC | Surgery | 1000 Pinhook Road, Suite 310, Lafayette, LA 70503-2460 | 2011-10-12 |
| 1275812976 | Flatirons Surgical Specialists, Pllc | Surgery | 2668 N Park Dr, Ste 110, Lafayette, CO 80026-3199 | 2011-08-11 |
| 1194017889 | Ethel Stackhouse Smith | Surgery | 125 Karolwood Dr, Lafayette, LA 70503 | 2011-05-12 |
| 1306137666 | Imtiaz R Khan | Surgery | 5000 Ambassador Caffery Pkwy Ste A, Lafayette, LA 70508-6984 | 2011-04-21 |
| 1386963148 | Leopold Richard, Jr. | Surgery | 406 Oakleaf Dr, Lafayette, LA 70503-3491 | 2010-05-19 |
| 1275760019 | Gary Joseph Arnold | Surgery | 302 Mill Valley Run, Lafayette, LA 70508 | 2009-06-19 |
| 1962681551 | Dennis Joseph Eschete Jr. | Surgery | 1000 W Pinhook Road, Ste 204, Lafayette, LA 70503-2460 | 2007-10-31 |
| 1902999485 | Joseph Peter Lupo | Surgery | 900 E Saint Mary Blvd Ste 104, Lafayette, LA 70503-2378 | 2006-10-02 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.