Active NPI
Karen Olsen Kennedy
- Pediatrics Physician
- Tacoma, WA
National Provider Identifier
1932175734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 54035
- Practice address
- 9040 Jackson Ave
Tacoma, WA 98431-3510 - Phone
- (253) 968-3066
- NPI assigned
- Feb 23, 2006
- Last updated
- Jul 25, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 54035 | MA | Primary |
Addresses
Primary practice location
9040 Jackson Ave
Tacoma, WA 98431-3510
Mailing address
637 Washington St
Dorchester Center, MA 02124-3510
Phone (617) 825-9660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3103102 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| US Dept of HHS | Current | Accepting new patients | |
| U S Health Dept of Health & Human Services | Current | Accepting new patients | |
| US Health Dept of Health & Human Services | Current | Accepting new patients |
Locations
669 Agency Main St
Harlem, MT 59526
Phone (406) 353-3100
Organizations & group practices 3
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.
-
dba Lodge Grass Clinic
- Critical Access Hospital
- Lodge Grass, MT
- NPI 1750410395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721865600000",
"number": "1932175734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "637 WASHINGTON ST",
"city": "DORCHESTER CENTER",
"state": "MA",
"postal_code": "021243510",
"telephone_number": "617-825-9660",
"fax_number": "617-288-7898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984313510",
"telephone_number": "253-968-3066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "KAREN",
"middle_name": "OLSEN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-23",
"last_updated": "2024-07-25",
"certification_date": "2024-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "54035",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3103102",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.