Provider Demographics
NPI:1407350424
Name:MAYNARD, BUFFY MICHELLE (APRN, FAMILY)
Entity Type:Individual
Prefix:
First Name:BUFFY
Middle Name:MICHELLE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:APRN, FAMILY
Other - Prefix:
Other - First Name:BUFFY
Other - Middle Name:M
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:4301 W MARKHAM ST # 519
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-7977
Practice Address - Fax:501-686-7522
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily