Healthcare Provider Details

I. General information

NPI: 1942618731
Provider Name (Legal Business Name): BARRY MAUPIN ACNP-BC, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18158 W DESERT SAGE DR
GOODYEAR AZ
85338-7846
US

IV. Provider business mailing address

PO BOX 7294
GOODYEAR AZ
85338-0639
US

V. Phone/Fax

Practice location:
  • Phone: 623-760-7660
  • Fax: 567-243-7800
Mailing address:
  • Phone: 623-760-7660
  • Fax: 567-243-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP5737
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5737
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP5737
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: