MEDICARE: VALARIE PONDER

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
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1639774037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALARIE PONDER

Provider Business Mailing Address
First Line	:	9744 LEMON GRASS LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1965
Country	:	US
Telephone Number	:	904-609-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	9744 LEMON GRASS LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-1965
Country	:	US
Telephone Number	:	904-609-4346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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Directions to “ VALARIE PONDER ” Practice Location

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