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NPI Code Detail

MEDICARE: KENNEDY CHRISTINE NIES DO

MEDICARE: KENNEDY CHRISTINE NIES DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208100000XPhysical Medicine & Rehabilitation Physician11022744AIN

General Provider Information

NPI Number : 1700527603
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY CHRISTINE NIES DO
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2231 CAREW ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4713
Country : US
Telephone Number : 260-425-6780
Fax Number : 260-373-9225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 05/27/2026

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Directions to “ KENNEDY CHRISTINE NIES DO” Practice Location

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