Individual
COLBY PONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 W HAMILTON ST, HOUSTON, MS 38851-2209
(662) 598-8141
(662) 796-3126
Mailing address
2434 S EASON BLVD, TUPELO, MS 38804-6942
(662) 640-4595
(662) 680-6416
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903137
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018203
—
MS
Enumeration date
01/22/2019
Last updated
02/13/2023
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