Individual provider · Type 1 NPI

Alicia Nichole Ponder, PA-C

Medical Physician Assistant · Fort Campbell, KY

NPI number 1396371035 Active

Practice location

5979 Desert Storm Ave
Fort Campbell, KY 42223-5514

Call (082) 273-5348 Map

Mailing address

129 Garland Way
Russellville, KY 42276-1128

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XNone listed
Medical Physician Assistant Primary 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

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About NPI 1396371035

Alicia Nichole Ponder, PA-C's National Provider Identifier is 1396371035, issued on Mar 13, 2020. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Fort Campbell, KY. The record was last updated on Jun 24, 2026.