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NPI Code Detail

MEDICARE: KLISTA MARIE MAYNARD BA

MEDICARE: KLISTA MARIE MAYNARD BA
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
1171M00000XCase Manager/Care CoordinatorWV

General Provider Information

NPI Number : 1285565325
Entity Type Code : Individual
Provider Name (Legal Business Name) : KLISTA MARIE MAYNARD BA
Provider Business Mailing Address
First Line : 99 CRACKER BARREL DR STE 100
Second Line :
City : BARBOURSVILLE
State : WV
Zip : 25504-1650
Country : US
Telephone Number : 304-525-7851
Fax Number : 304-525-1073
Provider Business Practice Location Address
First Line : 55 DONOHOE DR
Second Line :
City : HUNTINGTON
State : WV
Zip : 25705-8887
Country : US
Telephone Number : 304-525-7851
Fax Number : 304-525-1073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ KLISTA MARIE MAYNARD BA” Practice Location

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