Provider Demographics
NPI:1891798609
Name:HONEYCUTT, MARY ANN (RNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:RNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7293 DUMOSA AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3700
Mailing Address - Country:US
Mailing Address - Phone:760-369-7166
Mailing Address - Fax:760-369-7167
Practice Address - Street 1:7293 DUMOSA AVE STE 8
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3700
Practice Address - Country:US
Practice Address - Phone:760-369-7166
Practice Address - Fax:760-369-7167
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207997163W00000X
CARN207997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA207997OtherREGISTERED NURSE PRACTITI
CAZZZ29613ZMedicare PIN
CAP67567Medicare UPIN