# STEPHENIE RENEE INGRAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1407129372
- **Gender:** F
- **Credential:** CNP-FAMILY

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 72256 | OK | Yes |
| 363LF0000X | Family Nurse Practitioner | 72256 | OK | — |

## Other

- **Enumeration date:** 02/22/2012
- **Last updated:** 01/10/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200426120A | — | OK |