Healthcare Provider Details

I. General information

NPI: 1669702957
Provider Name (Legal Business Name): JEAN ANN INGRAM LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEAN ANN CATES LPN

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 HWY 70 W
MEAD OK
73449-1216
US

IV. Provider business mailing address

5912 HWY 70 W
MEAD OK
73449
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9083
  • Fax: 580-745-9885
Mailing address:
  • Phone: 580-745-9083
  • Fax: 580-745-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number20104
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: