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NPI Code Detail

MEDICARE: JACOB PATRICK KELLY MD

MEDICARE: JACOB PATRICK KELLY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician119045AK
2207RA0001XAdvanced Heart Failure and Transplant Cardiology Physician119045AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851551949
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB PATRICK KELLY MD
Provider Business Mailing Address
First Line : 3841 PIPER ST STE T100
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-4674
Country : US
Telephone Number : 907-561-3211
Fax Number :
Provider Business Practice Location Address
First Line : 3841 PIPER ST STE T100
Second Line :
City : ANCHORAGE
State : AK
Zip : 99508-4674
Country : US
Telephone Number : 907-561-3211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2008
Last Update Date : 01/14/2026

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