Individual
STEPHENIE RENEE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP-FAMILY
Contact information
Practice address
210 W MAIN ST, WILBURTON, OK 74578-4046
(918) 465-9612
(918) 465-9613
Mailing address
210 W MAIN ST, WILBURTON, OK 74578-4046
(918) 465-9612
(918) 465-9613
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
72256
OK
363LF0000X
Family Nurse Practitioner
72256
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200426120A
—
OK
Enumeration date
02/22/2012
Last updated
01/10/2024
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