Individual
KATRINA MAVIS INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17612 E 78TH ST N UNIT B, OWASSO, OK 74055-5815
(918) 730-2461
Mailing address
17612 E 78TH ST N UNIT B, OWASSO, OK 74055-5815
(918) 730-2461
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
OK
Other
Enumeration date
05/26/2023
Last updated
05/26/2023
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