Provider Demographics
NPI:1669702957
Name:INGRAM, JEAN ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ANN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:CATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5912 HWY 70 W
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:OK
Mailing Address - Zip Code:73449
Mailing Address - Country:US
Mailing Address - Phone:580-745-9083
Mailing Address - Fax:580-745-9885
Practice Address - Street 1:5912 HWY 70 W
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:OK
Practice Address - Zip Code:73449-1216
Practice Address - Country:US
Practice Address - Phone:580-745-9083
Practice Address - Fax:580-745-9885
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20104164W00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No164W00000XNursing Service ProvidersLicensed Practical Nurse