Provider Demographics
NPI:1275560849
Name:HONEYCUTT, STEPHEN RYAN (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RYAN
Last Name:HONEYCUTT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-391-7670
Mailing Address - Fax:504-378-9437
Practice Address - Street 1:1150 ROBERT BLVD STE 240
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2005
Practice Address - Country:US
Practice Address - Phone:985-646-3662
Practice Address - Fax:985-646-3691
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPAA10589RX363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1624942Medicaid
LAQ07876Medicare UPIN
LA1624942Medicaid