Healthcare Provider Details

I. General information

NPI: 1720769615
Provider Name (Legal Business Name): ANNA LOUISE HONEYCUTT NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S FLEISHEL AVE STE 5000
TYLER TX
75701-2015
US

IV. Provider business mailing address

155 FAIRWAY DR
BULLARD TX
75757-9371
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-2992
  • Fax:
Mailing address:
  • Phone: 903-203-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1129519
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1129519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: