Provider Demographics
NPI:1932703410
Name:INGRAM, KRISTIN LAUREN (DNP)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LAUREN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1634
Mailing Address - Country:US
Mailing Address - Phone:434-249-5417
Mailing Address - Fax:
Practice Address - Street 1:11 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1634
Practice Address - Country:US
Practice Address - Phone:434-249-5417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily