Healthcare Provider Details

I. General information

NPI: 1275157539
Provider Name (Legal Business Name): JOHN CHRISTOPHER MAYNARD APRN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AIRPORT GARDENS RD STE 311
HAZARD KY
41701-9529
US

IV. Provider business mailing address

151 SAMMONS LN
FOREST HILLS KY
41527-8307
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-6978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014729
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56919
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: