Provider Demographics
NPI:1972887123
Name:INGRUM, CASSIE COULTER (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:COULTER
Last Name:INGRUM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 RIGDEN MILL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8650
Mailing Address - Country:US
Mailing Address - Phone:256-431-6946
Mailing Address - Fax:
Practice Address - Street 1:2445 MEMORIAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5156
Practice Address - Country:US
Practice Address - Phone:615-217-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily