Individual
ALICIA ANN INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
100 MALLARD CREEK RD, SUITE 320, LOUISVILLE, KY 40207-4194
(502) 690-8782
(502) 459-0923
Mailing address
100 MALLARD CREEK RD, SUITE 320, LOUISVILLE, KY 40207-4194
(502) 690-8782
(502) 459-0923
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1106765
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200991930
—
IN
01
—
48489
CRNA
KY
05
—
7100129890
—
KY
01
—
RN335792
OHIO RN LICENSE
OH
Enumeration date
01/05/2010
Last updated
07/23/2024
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