NPIMap

Individual provider Active NPI

Timothy Maynard

  • Family Nurse Practitioner
  • Ceredo, WV
National Provider Identifier
1942618657
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3008802 Issued in KY
Practice address
402 C Street
Ceredo, WV 25507
Phone
(304) 908-1204
Fax
(304) 908-1224
NPI assigned
Jul 25, 2014
Last updated
Mar 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3008802 KY Primary

Addresses

Primary practice location

402 C Street
Ceredo, WV 25507

Mailing address

PO Box 1251
Ceredo, WV 25507-1251
Phone (304) 908-1204

Other practice location 1

303 6th Street West
Suite 7
Ceredo, WV 25507
Phone (304) 908-1204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20150204000172 WV Practitioner - Nurse Practitioner 2466777966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oncall Health and Aesthetic CareGroup PAC ID 9638472525, 10 clinicians

Practice addresses (Care Compare)

402 C St
Ceredo, WV 25507-1515
Phone (304) 908-1204

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3008802KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oncall Health and Aesthetic Care Family CurrentSince Oct 3, 2015 Accepting new patients
David J. Humphreys, MD, Psychiatrist Inc. Past Accepting new patients

Locations

303 W 6th St
Ste 7
Ceredo, WV 25507
Phone (304) 654-1612

402 W 4th St
Ceredo, WV 25507

Interoperability endpoints

  • Direct secure messaging: maynard-tim@e3dfd6d2.micromddirect.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1942618657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1251",
            "city": "CEREDO",
            "state": "WV",
            "postal_code": "255071251",
            "telephone_number": "304-908-1204",
            "fax_number": "304-908-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 C STREET",
            "city": "CEREDO",
            "state": "WV",
            "postal_code": "25507",
            "telephone_number": "304-908-1204",
            "fax_number": "304-908-1224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 6th Street West",
            "address_2": "Suite 7",
            "address_purpose": "LOCATION",
            "city": "Ceredo",
            "state": "WV",
            "postal_code": "25507",
            "country_code": "US",
            "telephone_number": "304-908-1204",
            "fax_number": "304-908-1224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "TIMOTHY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-25",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3008802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ceredo, WV

Sources for this page

Verify at the official NPI Registry.