Provider Demographics
NPI:1700527603
Name:NIES, KENNEDY CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:CHRISTINE
Last Name:NIES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KENNEDY
Other - Middle Name:
Other - Last Name:NIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST STE 4300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2394
Mailing Address - Country:US
Mailing Address - Phone:317-963-2011
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH STREET ROOM 4300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1308
Practice Address - Country:US
Practice Address - Phone:317-963-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN11022744A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program