Provider Demographics
NPI:1629550330
Name:INGRAM, EMILY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
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 1:2445 MURPHY MILL RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1595
Mailing Address - Country:US
Mailing Address - Phone:334-564-8255
Mailing Address - Fax:
Practice Address - Street 1:2445 MURPHY MILL RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-564-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2019-03-30
Deactivation Date:2018-10-25
Deactivation Code:
Reactivation Date:2018-11-21
Provider Licenses
StateLicense IDTaxonomies
AL1-145312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner