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NPI Code Detail

MEDICARE: KANDIS INGRAM

MEDICARE: KANDIS 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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1609704220
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANDIS INGRAM
Provider Business Mailing Address
First Line : 3724 JEFFERSON ST STE 104
Second Line :
City : AUSTIN
State : TX
Zip : 78731-6204
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3724 JEFFERSON ST STE 104
Second Line :
City : AUSTIN
State : TX
Zip : 78731-6204
Country : US
Telephone Number : 336-915-6737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ KANDIS INGRAM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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