Provider Demographics
NPI:1740727445
Name:STUART HUNINGHAKE, DAVONIA O (PA-C)
Entity type:Individual
Prefix:
First Name:DAVONIA
Middle Name:O
Last Name:STUART HUNINGHAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10201 GATEWAY BLVD W STE 130
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7647
Mailing Address - Country:US
Mailing Address - Phone:915-594-1000
Mailing Address - Fax:915-594-1007
Practice Address - Street 1:10201 GATEWAY BLVD W STE 130
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7647
Practice Address - Country:US
Practice Address - Phone:915-594-1000
Practice Address - Fax:915-594-1007
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2193363A00000X
TXPA15925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant