Provider Demographics
NPI:1902278278
Name:INGRAM, NAZNEEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NAZNEEN
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E PLEASANT RUN RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1876
Mailing Address - Country:US
Mailing Address - Phone:469-495-9150
Mailing Address - Fax:
Practice Address - Street 1:420 E PLEASANT RUN RD STE 330
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1876
Practice Address - Country:US
Practice Address - Phone:469-495-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA10188OtherPA LICENSE