Provider Demographics
NPI:1811235476
Name:PONDER, JULIE S (C-WHNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:S
Last Name:PONDER
Suffix:
Gender:F
Credentials:C-WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 STARBRUSH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-0995
Mailing Address - Fax:985-893-8910
Practice Address - Street 1:77 STARBRUSH CIRCLE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-893-0995
Practice Address - Fax:985-893-8910
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101529363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101529OtherNP LIC. #