Provider Demographics
NPI:1063661635
Name:MAYNARD, KIMBERLY SUE (CRNP-F)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22221 WESTERNPORT RD SW
Mailing Address - Street 2:
Mailing Address - City:MCCOOLE
Mailing Address - State:MD
Mailing Address - Zip Code:21562-2206
Mailing Address - Country:US
Mailing Address - Phone:301-533-3300
Mailing Address - Fax:301-533-3299
Practice Address - Street 1:22221 WESTERNPORT RD SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562
Practice Address - Country:US
Practice Address - Phone:240-774-0204
Practice Address - Fax:301-533-3299
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144591363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily