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Individual

BRENDA LEIGH INGRAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
115 AIRPORT RD, SULPHUR SPRINGS, TX 75482-2105
(903) 885-7671
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03143
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
313744004
TX
05
313744005
TX
05
313744006
TX
05
313744007
TX
01
75-0818167-015
TRICARE
TX
01
75-0818167-022
TRICARE
TX
01
75-0818167-044
TRICARE
TX
01
75-0818167-048
TRICARE
TX
01
75-1976930-005
TRICARE
TX
01
75-2616977-001
TRICARE
TX
01
75-2616977-002
TRICARE
TX
01
75-2616977-028
TRICARE
TX
01
75-2616977-129
TRICARE
TX
01
8478MA
BCBS
TX
01
8479MA
BCBS
TX
01
P01761904
RAIL ROAD MEDICARE
TX
01
P01762486
RAIL ROAD MEDICARE
TX
Enumeration date
08/20/2006
Last updated
02/10/2017
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