Provider Demographics
NPI:1982393468
Name:PONDER, EMILY KAY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KAY
Last Name:PONDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 NAPIER RD
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40409-8703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:328 NAPIER RD
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:KY
Practice Address - Zip Code:40409-8703
Practice Address - Country:US
Practice Address - Phone:606-308-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program