Individual
SEAN E MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
73 KINGSWOOD DR, CAMPBELLSVILLE, KY 42718-9604
(270) 849-2379
(270) 465-2126
Mailing address
67 KINGSWOOD DR, CAMPBELLSVILLE, KY 42718-9647
(270) 465-3812
(270) 465-8352
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PA592
KY
363AM0700X
Medical Physician Assistant
Primary
PA592
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9500143400
—
KY
Enumeration date
08/18/2005
Last updated
02/27/2024
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