Provider Demographics
NPI:1275157539
Name:MAYNARD, JOHN CHRISTOPHER (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SAMMONS LN
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41527-8307
Mailing Address - Country:US
Mailing Address - Phone:606-625-0956
Mailing Address - Fax:
Practice Address - Street 1:151 SAMMONS LN
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:KY
Practice Address - Zip Code:41527-8307
Practice Address - Country:US
Practice Address - Phone:606-625-0956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56919363LF0000X
KY3014729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily