Basic Information
| Provider Information | |||||||||
| NPI: | 1356381586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANIES | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | IRENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636019 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636019 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1818 ALBION ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372082918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153414000 | ||||||||
| FaxNumber: | 8652913228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 62680 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | CDR.0000963 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 87395 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | EMC721 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 91340 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20607 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.61134625 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 1109-320 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 40051 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3333606 | 05 | TN | MEDICAID | 4110131 | 01 | TN | BCBS | OTHER | P00364637 | 01 | TN | RAILROAD MEDICARE | OTHER | 890-24354 | 01 | AL | BCBS | OTHER |