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NPI Code Detail

MEDICARE: SARAH PONDER PAC

MEDICARE: SARAH PONDER PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant200107LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639294564
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH PONDER PAC
Provider Business Mailing Address
First Line : 18509 RED OAK DR
Second Line :
City : PRAIRIEVILLE
State : LA
Zip : 70769-3742
Country : US
Telephone Number : 225-677-7124
Fax Number :
Provider Business Practice Location Address
First Line : 7777 HENNESSY BLVD STE 5000
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-4368
Country : US
Telephone Number : 225-765-7163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 06/11/2021

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Directions to “ SARAH PONDER PAC” Practice Location

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