Healthcare Provider Details

I. General information

NPI: 1780503896
Provider Name (Legal Business Name): KATHRYN INGRAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BERNARD RD
ROCKY MOUNT VA
24151-6614
US

IV. Provider business mailing address

25 BERNARD RD
ROCKY MOUNT VA
24151-6614
US

V. Phone/Fax

Practice location:
  • Phone: 540-483-0280
  • Fax:
Mailing address:
  • Phone: 540-483-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005245
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: