Provider Demographics
NPI:1972536738
Name:PONTON, KATHERINE ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANN
Last Name:PONTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:236 BAILEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2573
Mailing Address - Country:US
Mailing Address - Phone:409-541-3133
Mailing Address - Fax:757-674-6747
Practice Address - Street 1:51 MDG/SGOSA UNIT 2060
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:AP
Practice Address - Country:KR
Practice Address - Phone:0018231-661-5169
Practice Address - Fax:0018231-661-6828
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645576367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered