MEDICARE: MRS. CATHY INGALLS WHNP

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	363LW0102X	Women's Health Nurse Practitioner	138054	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518959139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHY INGALLS WHNP

Provider Business Mailing Address
First Line	:	6633 HWY 37
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723
Country	:	US
Telephone Number	:	417-354-8657
Fax Number	:	417-354-8607

Provider Business Practice Location Address
First Line	:	6633 HIGHWAY 37
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723
Country	:	US
Telephone Number	:	417-354-8657
Fax Number	:	417-354-8607

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/09/2016

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