Provider Demographics
NPI:1972078335
Name:INGLE, VICTORIA IOAN (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:IOAN
Last Name:INGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:NICOLE
Other - Last Name:IOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 10TH AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3882
Mailing Address - Country:US
Mailing Address - Phone:828-322-2183
Mailing Address - Fax:828-485-2703
Practice Address - Street 1:304 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3883
Practice Address - Country:US
Practice Address - Phone:828-322-2183
Practice Address - Fax:828-485-2703
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08131363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1972078335Medicaid