Healthcare Provider Details

I. General information

NPI: 1629382130
Provider Name (Legal Business Name): REBECCA HONEYCUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 UPCHURCH RD
DUBACH LA
71235-2558
US

IV. Provider business mailing address

253 UPCHURCH RD
DUBACH LA
71235-2558
US

V. Phone/Fax

Practice location:
  • Phone: 318-577-0579
  • Fax:
Mailing address:
  • Phone: 318-577-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number310822
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: