Kathleen Blake Maynard, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

067211-23 Issued in NH

Practice address

3073 White Mountain Hwy
Primary Care, Memorial Hospital
North Conway, NH 03860-7101

Phone

(603) 356-5461

NPI assigned

Jul 11, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NH, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edward M Kennedy Community Health Center IncGroup PAC ID 3476512740, 65 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kathleen.maynard.d1.p1@direct.emkchc.nextgenshare.com
• FHIR API: https://api.platform.athenahealth.com/20740/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1609842152
  Medicare reassignment Care Compare group NPD
• Saco River Medical Group, PC

  • Family Medicine Physician
  • Conway, NH
  • NPI 1861587453
  Medicare reassignment NPD
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Worcester, MA
  • NPI 1316324650
  NPD
• Edward M. Kennedy Community Health Center, Inc

  • Clinic Pharmacy
  • Worcester, MA
  • NPI 1013048347
  NPD (past)
• Edward M. Kennedy Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Milford, MA
  • NPI 1992137426
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373500800000",
    "number": "1043651623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3073 WHITE MOUNTAIN HWY",
            "address_2": "PO BOX 5001",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038607101",
            "telephone_number": "603-356-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 WHITE MOUNTAIN HWY",
            "address_2": "PRIMARY CARE, MEMORIAL HOSPITAL",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038607101",
            "telephone_number": "603-356-5461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "KATHLEEN",
        "middle_name": "BLAKE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-11",
        "last_updated": "2013-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NH",
            "license": "067211-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William J Martin, MD
• Christopher A. Marvelli, MD
• Michelle Renee Mattei, MS PT
• Patricia Joan Mattox-Larson, M.S. CCC-SP
• Abigail Blake Maynard, FNP
• Clara Elizabeth McComb, DO
• Kathryn Elizabeth McDonald, RPH
• Thomas McDonough, DMD
• Dawn Marie McDougal, APN
• Katherine Elizabeth McGrath, DO

• Family Nurse Practitioner in North Conway, NH
• Providers in North Conway, NH by specialty
• Family Nurse Practitioner in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.