Provider Demographics
NPI:1518959139
Name:INGALLS, CATHY (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:INGALLS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 HWY 37
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723
Mailing Address - Country:US
Mailing Address - Phone:417-354-8657
Mailing Address - Fax:417-354-8607
Practice Address - Street 1:6633 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:PIERCE CITY
Practice Address - State:MO
Practice Address - Zip Code:65723
Practice Address - Country:US
Practice Address - Phone:417-354-8657
Practice Address - Fax:417-354-8607
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138054363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425908506Medicaid
MO425908522Medicaid
MO425908514Medicaid