Healthcare Provider Details
I. General information
NPI: 1043173743
Provider Name (Legal Business Name): TEARA MAYNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 12/08/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4021 CHESTNUT AVE
KANSAS CITY MO
64130-1331
US
IV. Provider business mailing address
4021 CHESTNUT AVE
KANSAS CITY MO
64130-1331
US
V. Phone/Fax
- Phone: 816-698-2308
- Fax:
- Phone: 816-698-2308
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251E00000X |
| Taxonomy | Home Health Agency |
| License Number | 101463A |
| License Number State | MO |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 311ZA0620X |
| Taxonomy | Adult Care Home Facility |
| License Number | 101463A |
| License Number State | MO |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 373H00000X |
| Taxonomy | Day Training/Habilitation Specialist |
| License Number | 101463A |
| License Number State | MO |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 376J00000X |
| Taxonomy | Homemaker |
| License Number | 101463A |
| License Number State | MO |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 146D00000X |
| Taxonomy | Personal Emergency Response Attendant |
| License Number | 101463A |
| License Number State | MO |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3747P1801X |
| Taxonomy | Personal Care Attendant |
| License Number | 101463A |
| License Number State | MO |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 385H00000X |
| Taxonomy | Respite Care |
| License Number | 101463A |
| License Number State | MO |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | 101463A |
| License Number State | MO |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 313M00000X |
| Taxonomy | Nursing Facility/Intermediate Care Facility |
| License Number | 101463A |
| License Number State | MO |
| # 10 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 374U00000X |
| Taxonomy | Home Health Aide |
| License Number | 101463A |
| License Number State | MO |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 314000000X |
| Taxonomy | Skilled Nursing Facility |
| License Number | 101463A |
| License Number State | MO |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 311500000X |
| Taxonomy | Alzheimer Center (Dementia Center) |
| License Number | 101463A |
| License Number State | MO |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251J00000X |
| Taxonomy | Nursing Care Agency |
| License Number | 101463A |
| License Number State | MO |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332BX2000X |
| Taxonomy | Oxygen Equipment & Supplies (DME) |
| License Number | 101463A |
| License Number State | MO |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3747A0650X |
| Taxonomy | Attendant Care Provider |
| License Number | 101463A |
| License Number State | MO |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
