Healthcare Provider Details

I. General information

NPI: 1891798609
Provider Name (Legal Business Name): MARY ANN HONEYCUTT RNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7293 DUMOSA AVE STE 8
YUCCA VALLEY CA
92284-3700
US

IV. Provider business mailing address

7293 DUMOSA AVE STE 8
YUCCA VALLEY CA
92284-3700
US

V. Phone/Fax

Practice location:
  • Phone: 760-369-7166
  • Fax: 760-369-7167
Mailing address:
  • Phone: 760-369-7166
  • Fax: 760-369-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN207997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number207997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: