Healthcare Provider Details

I. General information

NPI: 1386566297
Provider Name (Legal Business Name): TYRONIQUE INGRAM FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16777 MEDICAL CENTER DR
BATON ROUGE LA
70816-3228
US

IV. Provider business mailing address

1009 CHERIE LN
SLIDELL LA
70460-3988
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5200
  • Fax:
Mailing address:
  • Phone: 504-939-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number206496
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206496
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: