Provider Demographics
NPI:1831653583
Name:INGRAM, DESTINY AMY (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:AMY
Last Name:INGRAM
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:AMY
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5214 LIGHTNING VIEW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2240
Mailing Address - Country:US
Mailing Address - Phone:410-660-5576
Mailing Address - Fax:
Practice Address - Street 1:7711 QUARTERFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4492
Practice Address - Country:US
Practice Address - Phone:410-761-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily