Healthcare Provider Details

I. General information

NPI: 1659626786
Provider Name (Legal Business Name): ASHLEY RAE INGHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 PHILADELPHIA ST
INDIANA PA
15701-1595
US

IV. Provider business mailing address

2255 PHILADELPHIA ST STE A
INDIANA PA
15701-1595
US

V. Phone/Fax

Practice location:
  • Phone: 724-463-0476
  • Fax: 714-463-1196
Mailing address:
  • Phone: 724-463-0476
  • Fax: 724-463-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01024000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121970
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: