Provider Demographics
NPI:1487179636
Name:MAYNARD, AMY (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1573 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5888
Mailing Address - Country:US
Mailing Address - Phone:859-582-8449
Mailing Address - Fax:
Practice Address - Street 1:151 N EAGLE CREEK DR STE 320
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1893
Practice Address - Country:US
Practice Address - Phone:859-523-2526
Practice Address - Fax:859-523-2532
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011526367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife