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General NPI Number Information
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NPI Number | 1407129372
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Entity Type | Individual
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Provider Name | STEPHENIE RENEE INGRAM CNP-FAMILY
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 210 W MAIN ST
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City | WILBURTON
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State | OK
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Zip | 74578-4046
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Country | US
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Telephone | 918-465-9612
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Fax | 918-465-9613
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Provider Business Mailing Address
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Address Line | 210 W MAIN ST
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City | WILBURTON
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State | OK
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Zip | 74578-4046
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Country | US
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Telephone | 918-465-9612
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Fax | 918-465-9613
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 72256
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 72256
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License Number State | OK
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