Provider Demographics
NPI:1346454972
Name:PONCE, VALERIE LYNN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:LYNN
Last Name:PONCE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 GRAY DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2349
Mailing Address - Country:US
Mailing Address - Phone:276-623-0688
Mailing Address - Fax:
Practice Address - Street 1:246 MIDWAY MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1664
Practice Address - Country:US
Practice Address - Phone:423-989-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1030363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical