Gavin Grace Kane, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

10965 Issued in TN

Practice address

1821 W Broadway Ave
Maryville, TN 37801-5511

Phone

(865) 724-0852

Fax

(865) 724-0853

NPI assigned

Jul 11, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Patricia Hall Talbott Legacy Centers, LLC

  • Clinic/Center
  • Maryville, TN
  • NPI 1649897802
  NPD
• Gateway Treatment Centers, LLC

  • Clinic/Center
  • Ellijay, GA
  • NPI 1194459883
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1073247698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 W BROADWAY AVE",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378015511",
            "telephone_number": "865-724-0852",
            "fax_number": "865-724-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 W BROADWAY AVE",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378015511",
            "telephone_number": "865-724-0852",
            "fax_number": "865-724-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANE",
        "first_name": "GAVIN",
        "middle_name": "GRACE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "10965",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Renae Justice, OTR/L
• K -VA -T Food Stores Inc
• K VA T Food Stores Inc
• Tara Kadunce
• Brooke Kambic
• Pawel Gregorz Karolczak, M.D.
• Hannah Ruth Kasuli, NP-C
• Douglas Hugh Kauffman, MPT
• Melissa Ann Keane, PTA
• Kelsey Keller

• Social Worker in Maryville, TN
• Providers in Maryville, TN by specialty
• Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.