Provider Demographics
NPI:1215067541
Name:HONAKER, JASON KYLE (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:KYLE
Last Name:HONAKER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:SUITE 4K
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-721-4100
Mailing Address - Fax:910-721-4101
Practice Address - Street 1:257 HOSPITAL DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8411
Practice Address - Country:US
Practice Address - Phone:910-721-4100
Practice Address - Fax:910-721-4101
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-02-01
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Provider Licenses
StateLicense IDTaxonomies
NY014724363A00000X
VA0110002364363A00000X
NC0010-05410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant