Provider Demographics
NPI:1689286148
Name:HONEYCUTT, KELLY L (MA, RD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 HASSELL ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2606
Mailing Address - Country:US
Mailing Address - Phone:804-938-0602
Mailing Address - Fax:
Practice Address - Street 1:5016 HASSELL ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2606
Practice Address - Country:US
Practice Address - Phone:804-938-0602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA991862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered