NPIMap

Individual provider Active NPI

Kimberly Anne Maynard, NP

  • Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1376435263
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5022640 Issued in NC
Practice address
260 Robeson St
Fayetteville, NC 28301-5573
Phone
(919) 787-7247
NPI assigned
Jul 16, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5022640 NC Primary

Addresses

Primary practice location

260 Robeson St
Fayetteville, NC 28301-5573

Mailing address

3801 Wake Forest Rd Ste 210
Raleigh, NC 27609-6864
Phone (919) 787-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250930002412 NC Practitioner - Nurse Practitioner 4183120066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Spine and Pain Specialists PCGroup PAC ID 2860543097, 31 clinicians

Practice addresses (Care Compare)

260 Robeson St
Fayetteville, NC 28301-5573
Phone (910) 984-8311

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5022640NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Spine and Pain Specialists, PC CurrentSince Aug 1, 2025 Accepting new patients
Wake Spine & Pain Specialists PC CurrentSince Aug 1, 2025 Accepting new patients

Locations

260 Robeson St
Fayetteville, NC 28301
Phone (910) 984-8311

3801 Wake Forest Rd
Ste 210
Raleigh, NC 27609
Phone (919) 737-2034

Organizations & group practices 2

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1376435263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WAKE FOREST RD STE 210",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096864",
            "telephone_number": "919-787-7246",
            "fax_number": "919-787-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 ROBESON ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283015573",
            "telephone_number": "919-787-7247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5022640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.