MR. ANTONIO DENARD INGRAM (NPI# 1144585761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144585761 |
| Entity Type | Individual |
| Full Name | MR. ANTONIO DENARD INGRAM |
| Credential | FNP-BC |
| Practice Address |
1250 S Runnels St De Kalb TX 75559-2317 |
| Mailing Address |
118 Wood St De Kalb TX 75559-2112 |
| Practice Telephone | 9032808173 |
| Mailing Telephone | 9032808173 |
| Mailing Fax Number | 9039271764 |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2020-07-06 |
| NPI Deactivation Date | 05/10/2020 |
| NPI Reactivation Date | 2020-07-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 769058 | TX | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP136580 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1400 College Dr Ste 204, Texarkana, TX 75503 | 9379111110 | 9037919353 |
| Street Address |
1250 S RUNNELS ST |
| City | DE KALB |
| State | TX |
| Zip Code | 75559-2317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063413656 | Kyle Groom | Emergency Medicine | 1250 S Runnels St, De Kalb, TX 75559-2317 | 2005-08-03 |
| 1023632619 | Ingram Health Consulting | Community/Behavioral Health | 1250 S Runnels St, De Kalb, TX 75559-2317 | 2020-05-30 |
| 1174785687 | Janet Marlene Moreland | Physician Assistant | 1250 S Runnels St, De Kalb, TX 75559-2317 | 2008-06-26 |
| 1265565691 | Dekalb Physicians Clinic LLC | Family Medicine | 1250 S Runnels St, De Kalb, TX 75559-2317 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295138055 | Wal-mart Stores Texas LLC | Durable Medical Equipment & Medical Supplies | 12522 Fm 1840, De Kalb, TX 75559 | 2014-10-07 |
| 1114079001 | Hubbard Independent School District | Local Education Agency (LEA) | 3347 Hwy 259 South, De Kalb, TX 75559 | 2007-01-18 |
| 1306871561 | Save Mart Pharmacy | Durable Medical Equipment & Medical Supplies | 136 N Centre, Dekalb, TX 75559 | 2006-07-12 |
| 1427052000 | Dekalb Pharmacy LLC | Pharmacy | 120 W Front St, De Kalb, TX 75559-1308 | 2005-06-10 |
| 1063474807 | Janet Tidwell | Pharmacist | 120 W Front St, De Kalb, TX 75559-1308 | 2006-04-05 |
| 1104904044 | David Blair Hodges | Dentist | 109 Oak St, De Kalb, TX 75559-1359 | 2006-11-01 |
| 1669537247 | Christy M. Walls | Pharmacist | 120 W Front St, De Kalb, TX 75559-1371 | 2006-12-26 |
| 1285770180 | John Franklin Cary | Pharmacist | 136 N Centre St, De Kalb, TX 75559-1404 | 2007-01-29 |
| 1902978364 | Total Medical Supply | Durable Medical Equipment & Medical Supplies | 216 N Centre St, De Kalb, TX 75559-1406 | 2006-11-14 |
| 1720416308 | Almer Lee Hadaway Jr. | Nurse Practitioner | 216 N Centre St, De Kalb, TX 75559-1406 | 2013-10-17 |
| Find all providers in zip 75559 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770814576 | Dale Kay Shelton | Nurse Practitioner | 1282 Fm 2789, De Kalb, TX 75559-6103 | 2010-01-19 |
| 1104808732 | Martha Maxine Puckett | Nurse Practitioner | 14365 Highway 16 W, De Kalb, MS 39328-7974 | 2005-11-18 |
| 1326522319 | Sammy Elizabeth Kratzer | Nurse Practitioner | 14365 Highway 16 W, De Kalb, MS 39328-7974 | 2018-09-17 |
| 1669889457 | Hannah Gray | Nurse Practitioner | 201 Birch St, De Kalb, MS 39328-8017 | 2014-07-14 |
| 1720416308 | Almer Lee Hadaway Jr. | Nurse Practitioner | 216 N Centre St, De Kalb, TX 75559-1406 | 2013-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255162 | Shaida Rahmatinick | Nurse Practitioner | 1515 W 22nd St, Houston, TX 77008-1501 | 2020-11-08 |
| 1891396586 | Stacey Lynne Ready | Nurse Practitioner | 200 Uptmore Rd, West, TX 76691-2339 | 2020-11-08 |
| 1992306609 | Jillian Mcclintock | Nurse Practitioner | 2506 Graystone Ln, Corinth, TX 76210-1607 | 2020-11-08 |
| 1851992515 | Stacie A Gregg | Nurse Practitioner | 1229 Johnny Ln, San Angelo, TX 76905-2331 | 2020-11-07 |
| 1285235929 | Activate Family Health, Pllc | Nurse Practitioner | 203 E Davis St Ste F-1026, Conroe, TX 77301-3159 | 2020-11-07 |
| 1629679782 | Kristen Aili Johnson | Nurse Practitioner | 3850 Fm 18, Abilene, TX 79602-2004 | 2020-11-05 |
| 1376144303 | Stephanie Renee Knight | Nurse Practitioner | 4326 Egret Dr, Seabrook, TX 77586-2557 | 2020-11-05 |
| 1457952319 | Olufunke Oyindamola Oshoba | Nurse Practitioner | 200 Odyssey Ln, Mansfield, TX 76063-3438 | 2020-11-05 |
| 1518568419 | Ian Mardis | Nurse Practitioner | 12528 Tierra Encino Dr, El Paso, TX 79938-4525 | 2020-11-05 |
| 1851992994 | Angela Davis | Nurse Practitioner | 9523 Scanlan Heights Ln, Missouri City, TX 77459-5503 | 2020-11-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.