DR. ELAINE KENNEDY (NPI# 1083634935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083634935 |
| Entity Type | Individual |
| Full Name | DR. ELAINE KENNEDY |
| Credential | M.D. |
| Practice Address |
100 S Bliss Ave Pediatrics Clinic Tahlequah OK 74464-2512 |
| Mailing Address |
1390 Heritage Ln Pleasant View Apts # 92 Tahlequah OK 74464-2136 |
| Practice Telephone | 9184583120 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2011-01-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
MD0000010129 | TN | Allopathic & Osteopathic Physicians |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
00022200 | AL | Allopathic & Osteopathic Physicians |
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
044765 | GA | Allopathic & Osteopathic Physicians |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
21310 | SC | Allopathic & Osteopathic Physicians |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
34616 | KY | Allopathic & Osteopathic Physicians |
| N | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
22124 | WV | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629055843 | Elaine A. Kennedy | Physical Therapist | 333 Pearl St, Apt. 18l, New York, NY 10038-1609 | 2005-12-29 |
| 1437449725 | Elaine Christine Kennedy | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2011-04-08 |
| Street Address |
100 S BLISS AVE PEDIATRICS CLINIC |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-2512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194727198 | Owen Buck Gilmore | Family Medicine | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2005-08-10 |
| 1669085049 | Catherine Bailey Mcguffey | Physician Assistant | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2020-08-26 |
| 1679183404 | Kathryn Nicole Martin | Advanced Practice Midwife | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2020-08-06 |
| 1548882103 | Stacy Lynn Rutherford | Registered Nurse | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2020-05-17 |
| 1033739354 | Kelsey Kitchens | Audiologist | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2020-04-17 |
| 1952930257 | Athena Chatzigiannidis | Student in an Organized Health Care Education/Training Program | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2020-04-07 |
| 1942839394 | Sean Crawford | Student in an Organized Health Care Education/Training Program | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2020-04-07 |
| 1912544735 | Henri Jade Casey | Dentist | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2019-12-01 |
| 1831743624 | Sonny Jefferson James Downing | Pharmacist | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2019-07-30 |
| 1275190688 | Sam Blake Campbell | Dentist | 100 S Bliss Ave, Tahlequah, OK 74464-2512 | 2019-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609005842 | Ahmad Pediatrics | Pediatrics | 302 E Downing St, Tahlequah, OK 74464-3014 | 2009-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356544951 | Kristin Diane Conkling | Pediatrics | 5125 E 107th Pl, Tulsa, OK 74137-7236 | 2007-06-09 |
| 1780789362 | Children & Adolescent Medical Services Inc. | Pediatrics | 8803 S. 101st E. Ave., Suite 200, Tulsa, OK 74133 | 2006-09-14 |
| 1770504037 | Miguel Antonio Camacho-garrido | Pediatrics | 1104 Walnut Dr, Ardmore, OK 73401-2353 | 2006-07-22 |
| 1497788624 | Shelley Ann Bohn | Pediatrics | 937 Sw 89th St, Suite A, Oklahoma City, OK 73139-9231 | 2006-07-09 |
| 1922038348 | Paul Andrew Scott Benson | Pediatrics | 4444 E. 41st Street, 2nd Floor, Ou Physicians -- Pediatrics, Tulsa, OK 74135 | 2006-07-03 |
| 1235128430 | Elizabeth Gail Lewis | Pediatrics | 2701 Sw Cornell Ave, Lawton, OK 73505-7121 | 2005-10-19 |
| 1871581470 | Charles R Mettry | Pediatrics | 201 N Monte Vista St, Suite B, Ada, OK 74820-7200 | 2005-10-10 |
| 1578568010 | Julie Gail Sullivan | Pediatrics | 1615 S Eucalyptus Ave, Suite 210, Broken Arrow, OK 74012-6159 | 2005-06-20 |
| 1902446917 | Chelsea Ryan Walker | Pediatrics | 12455 E 100th St N Ste 300, Owasso, OK 74055-4678 | 2020-01-08 |
| 1235399122 | South Pointe Pediatrics, Pllc | Pediatrics | 1615 S Eucalyptus Ave, Suite 210, Broken Arrow, OK 74012-6159 | 2008-06-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.