MEDICARE: MRS. ALEXANDRIA MICHELLE INGRAM 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	AP144626	TX
2	363LF0000X	Family Nurse Practitioner	222242	OK

General Provider Information

NPI Number	:	1770115420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRIA MICHELLE INGRAM FNP-C

Provider Business Mailing Address
First Line	:	9228 S MINGO RD STE 102
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5721
Country	:	US
Telephone Number	:	918-592-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	9228 S MINGO RD STE 102
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5721
Country	:	US
Telephone Number	:	918-592-0999
Fax Number	:

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

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	01/24/2026

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