John B. Kelly Jr., D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

774 Issued in WV

Practice address

1220 Lee St E Ste 201
Charleston, WV 25301-1864

Phone

(304) 342-8513

Fax

(304) 342-8147

NPI assigned

Jul 28, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1982618690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 LEE ST E STE 201",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011864",
            "telephone_number": "304-342-8513",
            "fax_number": "304-342-8147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 LEE ST E STE 201",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011864",
            "telephone_number": "304-342-8513",
            "fax_number": "304-342-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JOHN",
        "middle_name": "B.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056727000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Klara Kelley
• Rebecca Kelley
• Geanetta Kellough
• Ashley Kelly
• Dawn Ann Kelly, PHARMACY TECHNICIAN
• Margaret Kelly
• Mariah Kelly
• Raighan Kelly
• Sheila Emerson Kelly, M.A.
• Tammy Lynn Kelly

• Family Medicine Physician in Charleston, WV
• Providers in Charleston, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.