Provider Demographics
NPI:1245276849
Name:INGRAM, MALINDA (FNP)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6391
Mailing Address - Country:US
Mailing Address - Phone:662-844-8754
Mailing Address - Fax:662-844-8741
Practice Address - Street 1:1041 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6391
Practice Address - Country:US
Practice Address - Phone:662-844-8754
Practice Address - Fax:628-448-7416
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363L00000X363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120516Medicaid
MS363L00000XOtherTAXONOMY
MS363L00000XOtherTAXONOMY
MSP47488Medicare UPIN