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DR. KELLEY A WOODRUFF M.D.
NPI 1619903416
Pediatrics - Adolescent Medicine in Tacoma, WA

Active since June 23, 2006PECOS Enrolled
9040 JACKSAON AVE, TACOMA, WA 98431(253) 459-5161 Get Directions Write a Review

NPPES record last updated: July 16, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Kelley A Woodruff M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLEY A WOODRUFF M.D. (NPI 1619903416) is an individual adolescent medicine provider in Tacoma, Washington, licensed in Hawaii (MD8054) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619903416
Entity TypeIndividualFemale
Primary Taxonomy2080A0000X
Provider Legal NameDR. KELLEY A WOODRUFFCredential: M.D.
Location Address9040 JACKSAON AVETacoma, WA 98431-0001
Mailing Address9040 Jacksaon AveTacoma, WA 98431-0001 · (253) 459-5161
Phone(253) 459-5161
Sole ProprietorNo
Enumeration DateJune 23, 2006
Last NPPES UpdateJuly 16, 2025
NPPES CertifiedJuly 16, 2025
✔ NPI 1619903416 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in HI · MD8054
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.

Also ListedPediatricsTaxonomy 208000000X · License MD8054 (HI)
Also ListedPediatrics · Obesity MedicineTaxonomy 2080B0002X · License MD8054 (HI)
Also ListedPediatrics · Pediatric Hematology-OncologyTaxonomy 2080P0207X · License MD8054 (HI)
9040 JACKSAON AVE, Tacoma, WA 98431
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Other Identifiers 4

Other753021507HI · Hilb,hma,hmaa
Other0000D06595HI · Hmsa,hmsa Quest,bcbs
OtherMD805403HI · Aet,nylc,pbp,uhc,qhcp
Medicaid05727601HI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelley A Woodruff M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelley Woodruff's NPI number?

The NPI number for Kelley Woodruff is 1619903416. It was assigned to this individual provider in the NPPES registry on June 23, 2006.

Where is Kelley Woodruff located?

Kelley Woodruff practices at 9040 Jacksaon Ave, Tacoma, WA 98431. The listed phone number is (253) 459-5161.

What is Kelley Woodruff's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Is Kelley Woodruff enrolled in Medicare?

Yes. Kelley Woodruff is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelley Woodruff was last updated on July 16, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.