Provider Demographics
NPI:1568504967
Name:NIES, KRISTIE J (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:J
Last Name:NIES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD STE 250
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3183 W STATE ST STE 1201
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1713
Practice Address - Country:US
Practice Address - Phone:423-764-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP07621103T00000X, 103G00000X
TNP1597103TC0700X, 103TP2701X, 103TR0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684094Medicare ID - Type Unspecified
TNR94708Medicare UPIN
TN6100516OtherUNITED HEALTHCARE
TN3684094Medicare ID - Type Unspecified
TN074792OtherBCBS VA
TN104066OtherVALUE OPTIONS
TN127267000OtherMAGELLAN
TN123113OtherMHN
TN9046232OtherPHCS
TN4067021OtherBCBSTN MEDICAL
TNR94708Medicare UPIN