MEDICARE: KATHERINE DELORES MAYNARD ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9287792	FL
2	363L00000X	Nurse Practitioner	APRN9287792	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194164269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DELORES MAYNARD ARNP

Provider Business Mailing Address
First Line	:	95186 SNAPDRAGON DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-0029
Country	:	US
Telephone Number	:	43-277-0969
Fax Number	:

Provider Business Practice Location Address
First Line	:	95186 SNAPDRAGON DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-0029
Country	:	US
Telephone Number	:	904-327-7096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	02/18/2025

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