Provider Demographics
NPI:1144585761
Name:INGRAM, ANTONIO DENARD (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DENARD
Last Name:INGRAM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CENTRAL FWY STE 180
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-2850
Mailing Address - Country:US
Mailing Address - Phone:940-257-0000
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTRAL FWY STE 180
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-2850
Practice Address - Country:US
Practice Address - Phone:940-257-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2024-01-31
Deactivation Date:2020-05-10
Deactivation Code:
Reactivation Date:2020-07-01
Provider Licenses
StateLicense IDTaxonomies
TX769058163W00000X
TXAP136580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse