Individual
TIMOTHY MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 C STREET, CEREDO, WV 25507
(304) 908-1204
(304) 908-1224
Mailing address
PO BOX 1251, CEREDO, WV 25507-1251
(304) 908-1204
(304) 908-1224
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3008802
KY
Other
Enumeration date
07/25/2014
Last updated
03/26/2026
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