Provider Demographics
NPI:1902376601
Name:MAYNARD, MEGAN (APRN, CNM)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:LERAE
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25708-0390
Mailing Address - Country:US
Mailing Address - Phone:304-429-1088
Mailing Address - Fax:
Practice Address - Street 1:245 FLEMINGSBURG RD STE A340
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1015
Practice Address - Country:US
Practice Address - Phone:606-207-2931
Practice Address - Fax:606-783-0964
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012042363LF0000X
KY4018424367A00000X
WV114780176B00000X
WV83431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife