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General NPI Number Information
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NPI Number | 1851573349
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Entity Type | Individual
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Provider Name | INGRID MARIE BLAY CANTRELL
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Gender | Female
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 6401 POPLAR AVE STE 300
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City | MEMPHIS
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State | TN
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Zip | 38119-4810
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Country | US
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Telephone | 800-999-1249
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Fax | 855-656-7325
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Provider Business Mailing Address
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Address Line | 9800 SHELBYVILLE RD STE 220
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City | LOUISVILLE
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State | KY
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Zip | 40223-2992
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Country | US
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Telephone | 305-595-0109
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Fax | 855-656-7325
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1562
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License Number State | TN
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