Individual
SHANNA M INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
15945 CLAYTON RD, BALLWIN, MO 63011-2382
(636) 256-5380
Mailing address
326 REARDON DR, KIRKWOOD, MO 63122-6452
(417) 880-6301
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F02240771
MO
Other
Enumeration date
05/06/2024
Last updated
05/06/2024
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