Individual
JACOB PATRICK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3841 PIPER ST STE T100, ANCHORAGE, AK 99508-4674
(907) 561-3211
Mailing address
3841 PIPER ST STE T100, ANCHORAGE, AK 99508-4674
(907) 561-3211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012-01069
NC
207R00000X
Internal Medicine Physician
N5767
TX
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
119045
AK
207RC0000X
Cardiovascular Disease Physician
119045
AK
390200000X
Student in an Organized Health Care Education/Training Program
2012-01069
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1668479
—
AK
05
—
1851551949
—
NC
Enumeration date
06/11/2008
Last updated
01/14/2026
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