Provider Demographics
NPI:1588856918
Name:PONDER, BRANDIE MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MARIE
Last Name:PONDER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:208 ACADIA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5624
Mailing Address - Country:US
Mailing Address - Phone:337-256-1311
Mailing Address - Fax:337-229-4065
Practice Address - Street 1:2535 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4363
Practice Address - Country:US
Practice Address - Phone:985-447-0921
Practice Address - Fax:985-447-0857
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP05138363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health