Provider Demographics
NPI:1972714095
Name:INGALLS, AMANDA L (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:INGALLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:TIMMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2713
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 410
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-442-2400
Practice Address - Fax:318-442-2427
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071978Medicaid
LA4N204Medicare PIN
LA1071978Medicaid