Individual
JOHN B. KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1220 LEE ST E STE 201, CHARLESTON, WV 25301-1864
(304) 342-8513
(304) 342-8147
Mailing address
1220 LEE ST E STE 201, CHARLESTON, WV 25301-1864
(304) 342-8513
(304) 342-8147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
774
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056727000
—
WV
Enumeration date
07/28/2006
Last updated
02/27/2020
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