DR. ELAINE KENNEDY M.D. NPI 1083634935

NPI Information

  • NPI: 1083634935
  • Provider Name: DR. ELAINE KENNEDY, M.D.
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 100 S BLISS AVE
    PEDIATRICS CLINIC
    TAHLEQUAH, OK
    ZIP 74464
  • Phone: (918) 458-3120

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NPI Details

DR. Elaine Kennedy, M.D. is an adolescent medicine pediatrics in Tahlequah, OK. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. DR. Elaine Kennedy, M.D. NPI is 1083634935. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

100 S BLISS AVE
PEDIATRICS CLINIC
TAHLEQUAH, OK
ZIP 74464-512
Phone: (918) 458-3120

The NPI 1083634935 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/20/2006 and was last updated on 1/6/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent Medicine22124WEST VIRGINIANo
22080A0000XPediatricsAdolescent Medicine34616KENTUCKYNo
32080A0000XPediatricsAdolescent Medicine21310SOUTH CAROLINANo
42080A0000XPediatricsAdolescent Medicine00022200ALABAMANo
52080A0000XPediatricsAdolescent MedicineMD0000010129TENNESSEENo
62080A0000XPediatricsAdolescent Medicine044765GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B03066MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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