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General NPI Number Information
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NPI Number | 1114279635
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Entity Type | Individual
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Provider Name | AMANDA LYNN MAYNARD FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 428 E MAIN ST
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City | INEZ
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State | KY
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Zip | 41224-8931
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Country | US
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Telephone | 606-298-2660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1269
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City | INEZ
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State | KY
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Zip | 41224-1269
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Country | US
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Telephone | 606-534-7500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007639
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 63087
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License Number State | WV
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