Provider Demographics
NPI:1275557878
Name:HONEYCUTT, JAMIE SUE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:SUE
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:SUE
Other - Last Name:PROFFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:420 WOLLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-1974
Mailing Address - Country:US
Mailing Address - Phone:816-470-2131
Mailing Address - Fax:816-470-7171
Practice Address - Street 1:420 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085
Practice Address - Country:US
Practice Address - Phone:816-470-2131
Practice Address - Fax:816-470-7171
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012802208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO37129037OtherBLUE CROSS BLUE SHIELD
MOP00476076OtherRAILROD MEDICARE
MO201015104Medicaid
MO201015104Medicaid
I42959Medicare UPIN