Healthcare Provider Details

I. General information

NPI: 1245276849
Provider Name (Legal Business Name): MALINDA INGRAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 S MADISON ST
TUPELO MS
38801-6391
US

IV. Provider business mailing address

1041 S MADISON ST
TUPELO MS
38801-6391
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-8754
  • Fax: 628-448-7416
Mailing address:
  • Phone: 662-844-8754
  • Fax: 662-844-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number363L00000X
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: