MEDICARE: DESHONDRA INGRAM IRBY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A006154	AR

General Provider Information

NPI Number	:	1316406861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHONDRA INGRAM IRBY FNP-C

Provider Business Mailing Address
First Line	:	8 DAVEN CT
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-2924
Country	:	US
Telephone Number	:	501-812-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 FORT ROOTS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-1709
Country	:	US
Telephone Number	:	501-257-3944
Fax Number	:	501-451-6791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	01/19/2026

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