Provider Demographics
NPI:1174311807
Name:MAXWELL, MYYA KEI MOUNTJOY (CPM)
Entity type:Individual
Prefix:
First Name:MYYA
Middle Name:KEI MOUNTJOY
Last Name:MAXWELL
Suffix:
Gender:
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 E 124TH TER
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1812
Mailing Address - Country:US
Mailing Address - Phone:573-289-3495
Mailing Address - Fax:
Practice Address - Street 1:7021 E 124TH TER
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1812
Practice Address - Country:US
Practice Address - Phone:573-289-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife