Provider Demographics
NPI:1477628402
Name:PONG, KATHY L (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:PONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 METRO CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744
Mailing Address - Country:US
Mailing Address - Phone:855-893-1031
Mailing Address - Fax:855-529-7674
Practice Address - Street 1:7301 METRO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744
Practice Address - Country:US
Practice Address - Phone:855-893-1031
Practice Address - Fax:855-529-7674
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily