Provider Demographics
NPI:1447843784
Name:PONCARDAS, JERMAIN C (RN)
Entity type:Individual
Prefix:MR
First Name:JERMAIN
Middle Name:C
Last Name:PONCARDAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E BATTLEFIELD ST APT D26
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5879
Mailing Address - Country:US
Mailing Address - Phone:417-450-9372
Mailing Address - Fax:
Practice Address - Street 1:821 E BATTLEFIELD ST APT D26
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5879
Practice Address - Country:US
Practice Address - Phone:417-450-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033355163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical