Provider Demographics
NPI:1225567431
Name:INGRAM, RORY BLYTHE (MSN, FNP-BC, CCRN)
Entity type:Individual
Prefix:
First Name:RORY
Middle Name:BLYTHE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MSN, FNP-BC, CCRN
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Other - Last Name:
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Mailing Address - Street 1:SOUTH CENTRAL FOUNDATION
Mailing Address - Street 2:4155 TUDOR CENTRE DRIVE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5912
Mailing Address - Country:US
Mailing Address - Phone:509-215-1700
Mailing Address - Fax:
Practice Address - Street 1:SOUTH CENTRAL FOUNDATION
Practice Address - Street 2:4155 TUDOR CENTRE DRIVE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5912
Practice Address - Country:US
Practice Address - Phone:509-215-1700
Practice Address - Fax:509-215-1700
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK192728363LF0000X
ID54633363LF0000X
OR10011262363LF0000X
FLAPRN11030726363LF0000X
HI3824-0363LF0000X
CA95007083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily