Provider Demographics
NPI:1972887123
Name:INGRUM, CASSIE COULTER (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:COULTER
Last Name:INGRUM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FITNESS WAY STE 2700
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2495
Mailing Address - Country:US
Mailing Address - Phone:256-233-9273
Mailing Address - Fax:256-216-1920
Practice Address - Street 1:101 FITNESS WAY STE 2700
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2495
Practice Address - Country:US
Practice Address - Phone:256-233-9273
Practice Address - Fax:256-216-1920
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily