Provider Demographics
NPI:1821166505
Name:HONEYCUTT, TERYN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:TERYN
Middle Name:ELIZABETH
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 S MICHIGAN AVE
Mailing Address - Street 2:#PH6
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2960
Mailing Address - Country:US
Mailing Address - Phone:708-646-8017
Mailing Address - Fax:
Practice Address - Street 1:1124 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8446
Practice Address - Country:US
Practice Address - Phone:815-744-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385-001166363AM0700X
IL085-002283363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical