| Doctor Name: | DR. ELAINE KENNEDY |
| NPI Number: | 1083634935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 22124 |
| Business Practice Address: | 100 S Bliss Ave Pediatrics Clinic Tahlequah, OK - 744642512 |
| Business Phone Number: | 9184583120 |
| Business Fax Number: | |
| Mailing Address: | 1390 Heritage Ln, Pleasant View Apts # 92 TAHLEQUAH |
| State: | OK |
| Postal Code: | 744642136 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 01/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2080A0000X |
| License Number: | 22124 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | 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. |