Individual
JOHN B KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3505 E MERIDIAN PARK LOOP STE 100, WASILLA, AK 99654-7242
(907) 416-6594
(800) 654-6250
Mailing address
3505 E MERIDIAN PARK LOOP STE 100, WASILLA, AK 99654-7242
(907) 416-6594
(800) 654-6250
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
203883
AK
2084N0400X
Neurology Physician
27953
KY
208VP0014X
Interventional Pain Medicine Physician
27953
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740353
—
AK
Enumeration date
07/21/2005
Last updated
02/09/2026
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