Provider Demographics
NPI:1083301329
Name:INGRAM, KATIE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:INGRAM
Suffix:
Gender:
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 REPUBLIC PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6920
Mailing Address - Country:US
Mailing Address - Phone:972-285-0838
Mailing Address - Fax:
Practice Address - Street 1:1650 REPUBLIC PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6920
Practice Address - Country:US
Practice Address - Phone:972-285-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113528363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics