Dwight Clesson Kellicut III, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

01053701A Issued in IN

Practice address

1 Jarrett White Rd
Tripler Army Medical Center, HI 96859-5001

Phone

(808) 433-6777

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1871518662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 BOUGAINVILLE DR # 115",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183179",
            "telephone_number": "864-455-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "city": "TRIPLER ARMY MEDICAL CENTER",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLICUT",
        "first_name": "DWIGHT",
        "middle_name": "CLESSON",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IN",
            "license": "01053701A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Kay
• Leanna Keen, MD
• Patrick Geary Keenan, PT, DSC
• Regina Keith, NP
• Jennifer Kelley, RN
• Kaleena Jae Kemper, CNM/WHNP
• Maya Khalil, PA
• Kori Kanoelani Kiesel-Weatherford, LCSW, DCSW, BCD
• Daeyun Kim, PHYSICIAN ASSISTANTS
• Jeong J Kim, FNP

• Vascular Surgery Physician in Tripler Army Medical Center, HI
• Providers in Tripler Army Medical Center, HI by specialty
• Vascular Surgery Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.