Basic Information
| Provider Information | |||||||||
| NPI: | 1891798609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HONEYCUTT | ||||||||
| FirstName: | MARY ANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7293 DUMOSA AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603697166 | ||||||||
| FaxNumber: | 7603697167 | ||||||||
| Practice Location | |||||||||
| Address1: | 7293 DUMOSA AVE STE 8 | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603697166 | ||||||||
| FaxNumber: | 7603697167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 207997 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | RN207997 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 207997 | 01 | CA | REGISTERED NURSE PRACTITI | OTHER |