MEDICARE: TRACY LEA INGRAM F.N.P., R.N.

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	71001970A	IN
2	363L00000X	Nurse Practitioner	71001970A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336133099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LEA INGRAM F.N.P., R.N.

Provider Business Mailing Address
First Line	:	3306 N COUNTY ROAD 420 W
Second Line	:
City	:	GREENSBURG
State	:	IN
Zip	:	47240-7793
Country	:	US
Telephone Number	:	812-663-7596
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 N LINCOLN ST
Second Line	:
City	:	GREENSBURG
State	:	IN
Zip	:	47240-1348
Country	:	US
Telephone Number	:	812-662-0588
Fax Number	:	812-663-5932

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/16/2008

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