MEDICARE: JASMINE JA'NET INGRAM

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1376408161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE JA'NET INGRAM

Provider Business Mailing Address
First Line	:	901 MOSS CLIFF CIR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4676
Country	:	US
Telephone Number	:	469-988-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 MOSS CLIFF CIR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4676
Country	:	US
Telephone Number	:	469-988-8252
Fax Number	:

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ JASMINE JA'NET INGRAM ” Practice Location

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