Provider Demographics
NPI:1710445804
Name:INGRAM, ALEXANDRIA FAILE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:FAILE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 JOHN EVERALL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-8515
Mailing Address - Country:US
Mailing Address - Phone:803-320-7696
Mailing Address - Fax:
Practice Address - Street 1:505 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1704
Practice Address - Country:US
Practice Address - Phone:803-283-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily