Provider Demographics
NPI:1477244168
Name:INGOLD, ADYSON MAE (PA)
Entity Type:Individual
Prefix:
First Name:ADYSON
Middle Name:MAE
Last Name:INGOLD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4210 S BOYD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67215-2044
Mailing Address - Country:US
Mailing Address - Phone:308-224-7617
Mailing Address - Fax:
Practice Address - Street 1:4210 S BOYD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67215-2044
Practice Address - Country:US
Practice Address - Phone:308-224-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant