Individual provider Active NPI

Caleb A Kennon, MD

  • Anesthesiology Physician
  • Newark, OH
National Provider Identifier
1144789918
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
35.154451 Issued in OH
Practice address
1320 W Main St
Newark, OH 43055-1822
Phone
(220) 564-4201
Fax
(220) 564-4219
NPI assigned
Mar 19, 2019
Last updated
Oct 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 71867 TN
Anesthesiology Physician 207L00000X 35.154451 OH Primary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 58148 KY

Addresses

Primary practice location

1320 W Main St
Newark, OH 43055-1822

Mailing address

1320 W Main St
Newark, OH 43055-1822
Phone (220) 564-4201

Other practice location 1

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011 ext. 402

Other practice location 2

800 Rose St
Lexington, KY 40536-0293
Phone (859) 323-5956

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ckennon44093@lickingmemorial.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, TN, OH3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20240909004454 KY Practitioner - Anesthesiology 0345780060 Reassigns benefits to 2 organizations
I20241114003182 TN Practitioner - AnesthesiologyPractitioner - Pain Management 0345780060 Reassigns benefits to 1 organization
I20251007002942 OH Practitioner - Anesthesiology 0345780060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Missouri, Kansas City, School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watauga Orthopaedics PLCGroup PAC ID 1456246479, 85 clinicians
Kentucky Medical Services Foundation, IncGroup PAC ID 5698689909, 949 clinicians

Practice addresses (Care Compare)

1320 W Main St
Licking Memorial Anesthesiology
Newark, OH 43055-1822
Phone (220) 564-4226

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011

800 Rose St
Lexington, KY 40536-0001
Phone (859) 323-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Watauga Orthopaedics PLC CurrentSince Oct 1, 2024 Accepting new patients
Licking Memorial Health Professionals Current Accepting new patients
Kentucky Medical Services Foundation, Inc Anesthesiology CurrentSince Aug 27, 2024 Accepting new patients
Licking Memorial Professional Corporation CurrentSince Oct 1, 2025 Accepting new patients
Watauga Orthopaedics, PLC CurrentSince Oct 1, 2024 Accepting new patients
University of Kentucky CurrentSince Aug 27, 2024 Accepting new patients
Licking Memorial Professional Corporation CurrentSince Oct 1, 2025 Accepting new patients
Licking Memorial Professional Corp. Past Accepting new patients

Locations

2400 Greatstone Pt
Lexington, KY 40504
Phone (859) 257-9800

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

120 McMillen Dr
Newark, OH 43055
Phone (220) 564-4806

1320 W Main St
Newark, OH 43055
Phone (740) 348-4151

2000 Tamarack Rd
Newark, OH 43055
Phone (740) 788-6000

340 Steeles Rd
Bristol, TN 37620
Phone (423) 282-9011

2410 Susannah St
Johnson City, TN 37601
Phone (423) 282-9011

2412 Susannah St
Johnson City, TN 37601
Phone (423) 282-8070

875 Larry Neil Way
Kingsport, TN 37660
Phone (423) 282-9011

Interoperability endpoints

  • Direct secure messaging: caleb.kennon.1@3374.direct.athenahealth.com
  • Direct secure messaging: ckennon33663@ukhcdirect.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1144789918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "220-564-4201",
            "fax_number": "220-564-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "220-564-4201",
            "fax_number": "220-564-4219"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2410 Susannah St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376011748",
            "country_code": "US",
            "telephone_number": "423-282-9011 x402",
            "fax_number": "423-282-0035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Rose St",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405360293",
            "country_code": "US",
            "telephone_number": "859-323-5956",
            "fax_number": "859-323-1080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNON",
        "first_name": "CALEB",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-19",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "71867",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35.154451",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "58148",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ckennon44093@lickingmemorial.medicity.net",
            "affiliation": "N",
            "address_1": "1320 W Main St",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430551822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.