1942448808 NPI number — AMBER DAWN PONDER CRNA

Table of content: AMBER DAWN PONDER CRNA (NPI 1942448808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942448808 NPI number — AMBER DAWN PONDER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PONDER
Provider First Name:
AMBER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPRY
Provider Other First Name:
AMBER
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942448808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2438 INDUSTRIAL BLVD. PMB 166
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-675-6466
Provider Business Mailing Address Fax Number:
325-692-6030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 ANTILLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-675-6466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  706455 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201284101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".