Provider Demographics
NPI:1750046959
Name:POUNG, WA
Entity Type:Individual
Prefix:
First Name:WA
Middle Name:
Last Name:POUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 COPPER RANCH AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-2854
Mailing Address - Country:US
Mailing Address - Phone:210-548-0698
Mailing Address - Fax:
Practice Address - Street 1:4909 COPPER RANCH AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-2854
Practice Address - Country:US
Practice Address - Phone:210-548-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048956363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1048956OtherTEXAS STATE BOARD OF NURSING