Provider Demographics
NPI:1801592415
Name:MAYNARD, KERI ANN (APRN)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:ANN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 SUNSHINE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7035
Mailing Address - Country:US
Mailing Address - Phone:270-508-0601
Mailing Address - Fax:
Practice Address - Street 1:2501 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3813
Practice Address - Country:US
Practice Address - Phone:270-575-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3018798OtherKENTUCKY BOARD OF NURSING