Individual provider Active NPI

Maureen A Gaynor, ARNP

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Kingsport, TN
National Provider Identifier
1730230681
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X
License
21311 Issued in TN
Practice address
1570 Waverly Rd
Kingsport, TN 37664-2523
Phone
(423) 224-1300
Fax
(423) 467-3644
NPI assigned
Jan 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 049181-23-08 NH
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X 21311 TN Primary

Addresses

Primary practice location

1570 Waverly Rd
Kingsport, TN 37664-2523

Mailing address

1167 Spratlin Park Dr
Gray, TN 37615-6205
Phone (423) 467-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, TN2 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

Enrollment IDStateProvider typePAC IDDetails
I20121205000380 NH Practitioner - Nurse Practitioner 4183876774 Reassigns benefits to 1 organization
I20170406000078 TN Practitioner - Nurse Practitioner 4183876774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Frontier HealthGroup PAC ID 2860302320, 70 clinicians

Practice addresses (Care Compare)

1167 Spratlin Park Dr
Gray, TN 37615-6205
Phone (423) 467-3600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Frontier Health CurrentSince Jan 15, 2017 Accepting new patients
Merrimack Valley Counseling Association Psychiatric/Mental Health CurrentSince Jan 28, 2020 Accepting new patients
Frontier Health CurrentSince Jan 15, 2017 Accepting new patients
Christiana Care Health Services Inc Past Accepting new patients
Christiana Care Health Services, Inc Past Accepting new patients

Locations

39 Simon St
Ste 2A
Nashua, NH 03060
Phone (603) 888-4347

39 Simon St
Ste 2
Nashua, NH 03060

1145 Volunteer Pkwy
Bristol, TN 37620
Phone (423) 989-4500

426 E G St
Elizabethton, TN 37643
Phone (423) 547-5950

218 N Main Ave
Erwin, TN 37650
Phone (423) 741-8263

401 Holston Dr
Greeneville, TN 37743
Phone (423) 639-1104

109 W Watauga Ave
Johnson City, TN 37604
Phone (423) 232-2600

1167 Spratlin Park Dr
Johnson City, TN 37615
Phone (423) 232-2670

607 Baxter St
Johnson City, TN 37601
Phone (423) 232-2670

1570 Waverly Rd
Kingsport, TN 37664
Phone (423) 224-1300

318 Donnelly St
Mountain City, TN 37683
Phone (423) 727-2100

101 Lena Dr
Rogersville, TN 37857
Phone (423) 272-9239

210 River Rd
Sneedville, TN 37869
Phone (423) 733-2061

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/5c7467fb-60f9-4172-add4-57667a5dfcfa/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1730230681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1167 SPRATLIN PARK DR",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376156205",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 WAVERLY RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376642523",
            "telephone_number": "423-224-1300",
            "fax_number": "423-467-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAYNOR",
        "first_name": "MAUREEN",
        "middle_name": "A",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NH",
            "license": "049181-23-08",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "TN",
            "license": "21311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.