Provider Demographics
NPI:1932347895
Name:PONDER, JONATHON TODD (CRNA)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:TODD
Last Name:PONDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 INDUSTRIAL BLVD
Mailing Address - Street 2:PMB 166
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-7205
Mailing Address - Country:US
Mailing Address - Phone:325-675-6466
Mailing Address - Fax:325-692-6030
Practice Address - Street 1:2120 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5211
Practice Address - Country:US
Practice Address - Phone:325-695-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697861367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L11786Medicare PIN