Provider Demographics
NPI:1902631161
Name:MAUPIN, CHARLES LEON III (RN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LEON
Last Name:MAUPIN
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 BAYBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-7107
Mailing Address - Country:US
Mailing Address - Phone:859-312-9503
Mailing Address - Fax:
Practice Address - Street 1:209 BAYBROOK CIR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-7107
Practice Address - Country:US
Practice Address - Phone:859-312-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1146834163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice