Healthcare Provider Details

I. General information

NPI: 1336859552
Provider Name (Legal Business Name): JENNIFER ANN INGHAM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST
BOSTON MA
02111-1521
US

IV. Provider business mailing address

7 DOROTHYS WAY
BEDFORD NH
03110-4348
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax: 617-636-4852
Mailing address:
  • Phone: 603-505-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN244245
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: