Elaine Kennedy, M.D.
Elaine Kennedy, M.D. is a Pediatric Adolescent Medicine Physician in Tahlequah, OK, registered under NPI 1083634935.
Getting there
The practice address on file is 100 S BLISS AVE PEDIATRICS CLINIC, Tahlequah, OK 74464. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| 044765 | GA | Pediatric Adolescent Medicine Physician primary |
| 22124 | WV | Pediatric Adolescent Medicine Physician |
| 34616 | KY | Pediatric Adolescent Medicine Physician |
| 21310 | SC | Pediatric Adolescent Medicine Physician |
| 00022200 | AL | Pediatric Adolescent Medicine Physician |
| MD0000010129 | TN | Pediatric Adolescent Medicine Physician |
Licences are recorded in 6 states: GA, WV, KY, SC, AL, TN. Providers licensed in several states often practise near a state border or deliver telehealth across state lines.
- Status
- Approved
- Provider type
- Practitioner - Pediatric Medicine
- PAC ID
- 2365474665
- Enrollment ID
- I20050907001257
Medicare enrolment is recorded as approved under the provider type Practitioner - Pediatric Medicine. Being enrolled means the provider can bill Medicare; it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
Licensed in 6 states
This provider holds licences in 6 states: Alabama, Georgia, Kentucky, South Carolina, Tennessee and West Virginia. Multi-state licensure often means the provider works near a state border, covers more than one office, or delivers care by telehealth. If the address above is far from you, it is worth calling to ask whether they practise closer to where you live.
- Licence
- 00022200
- Specialty
- Pediatric Adolescent Medicine Physician
- Licence
- 044765
- Specialty
- Pediatric Adolescent Medicine Physician
- Licence
- 34616
- Specialty
- Pediatric Adolescent Medicine Physician
- Licence
- 21310
- Specialty
- Pediatric Adolescent Medicine Physician
- Licence
- MD0000010129
- Specialty
- Pediatric Adolescent Medicine Physician
- Licence
- 22124
- Specialty
- Pediatric Adolescent Medicine Physician
Licence numbers are self-reported to NPPES at registration. They do not confirm a licence is currently active, in good standing, or valid for the specialty shown — only the state board can tell you that, which is why we link to each one.
What Adolescent Medicine covers
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. NUCC Health Care Provider Taxonomy, code 2080A0000X
All registered taxonomy codes
This provider registers 6 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 2080A0000X | Pediatric Adolescent Medicine Physician Adolescent Medicine | 044765 | GA | primary |
| 2080A0000X | Pediatric Adolescent Medicine Physician Adolescent Medicine | 22124 | WV | |
| 2080A0000X | Pediatric Adolescent Medicine Physician Adolescent Medicine | 34616 | KY | |
| 2080A0000X | Pediatric Adolescent Medicine Physician Adolescent Medicine | 21310 | SC | |
| 2080A0000X | Pediatric Adolescent Medicine Physician Adolescent Medicine | 00022200 | AL | |
| 2080A0000X | Pediatric Adolescent Medicine Physician Adolescent Medicine | MD0000010129 | TN |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-1 identifies a single person. It stays with the clinician for life, even if they move practice or change state, which is why the address on file can lag behind where they actually work today.
| NPI | 1083634935 valid check digit |
|---|---|
| Entity type | Individual (NPI-1) |
| Enumeration date | Jul 20, 2006 |
| Last updated | Jan 6, 2011 |
| Status | Active |
| Sole proprietor | No |
| Credential | M.D. |
| Practice address |
100 S BLISS AVE PEDIATRICS CLINIC Tahlequah, OK 74464 (918) 458-3120 |
| Mailing address |
1390 HERITAGE LN PLEASANT VIEW APTS # 92 Tahlequah, OK 74464 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 0 | 8 | 3 | 6 | 3 | 4 | 9 | 3 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 0 | 7 | 3 | 3 | 3 | 8 | 9 | 6 |
Sum = 65 · next multiple of 10 = 70 · check digit = 5 · actual last digit = 5
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.