Provider Demographics
NPI:1790259422
Name:INGRAM, JESSICA D (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:INGRAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 1ST ST N STE 500
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8740
Mailing Address - Country:US
Mailing Address - Phone:205-663-5775
Mailing Address - Fax:205-739-2049
Practice Address - Street 1:1022 1ST ST N STE 501
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8718
Practice Address - Country:US
Practice Address - Phone:205-663-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118562363LA2100X
AL1-116582363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care