Individual
CARRIE ELIZABETH INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 N 4TH ST, PONCA CITY, OK 74601-4527
(580) 749-5056
(580) 215-5762
Mailing address
110 N 4TH ST., PONCA CITY, OK 74601-1536
(580) 749-5056
(580) 215-5765
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/21/2021
Last updated
04/09/2021
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