Healthcare Provider Details

I. General information

NPI: 1972145563
Provider Name (Legal Business Name): STEVEN INGRAM CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 GRANDVIEW PKWY STE 200
BIRMINGHAM AL
35243-3411
US

IV. Provider business mailing address

3680 GRANDVIEW PKWY STE 200
BIRMINGHAM AL
35243-3411
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-7500
  • Fax: 205-971-7571
Mailing address:
  • Phone: 205-971-7500
  • Fax: 205-971-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-152225
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-152225
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: