Kenneth W Ponder MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME0063310 Issued in FL

Legal business name

KENNETH W PONDER MD PA

Practice address

4566 E Highway 20 Ste 103
Niceville, FL 32578-8839

Phone

(850) 897-1223

Fax

(850) 897-1237

NPI assigned

Sep 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Wayne Ponder, M.D.

Title

President

Phone

(850) 517-7877

Specialties & licenses 1

Addresses

Other names 1

• Bluewater Medicine Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640736000000",
    "number": "1962593574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4704 KNOLLWOOD RD",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788760",
            "telephone_number": "850-517-7877",
            "fax_number": "832-336-3826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20 STE 103",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788839",
            "telephone_number": "850-897-1223",
            "fax_number": "850-897-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH W PONDER MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A",
        "authorized_official_last_name": "PONDER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-517-7877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0063310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluewater Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bluewater Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtney Leigh Keith, RD
• Nicole Marie Keller, PT, DPT
• Dianne Kelly Smith, DNP, APRN
• Colby Laine Kelly, LCSW
• Elizabeth Kelton
• Kidz Korner
• Kit D. Kuss MD PA
• Paige Klosterman
• Ashley Knarzer, MD
• Brittany Kotowske, PHARMD

• Internal Medicine Physician in Niceville, FL
• Providers in Niceville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.