Healthcare Provider Details

I. General information

NPI: 1679255210
Provider Name (Legal Business Name): JESSICA MARY PONDER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S PARKER RD STE 201
DENVER CO
80231-8068
US

IV. Provider business mailing address

887 GOLDEN PEAK DR
ERIE CO
80516-9118
US

V. Phone/Fax

Practice location:
  • Phone: 303-802-5444
  • Fax:
Mailing address:
  • Phone: 720-594-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998985-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRXN.0108172-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: