Octavia Ingram, DNP, FNP-C, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403475 Issued in NY

Practice address

13729 Tab Dr
Northport, AL 35475-1694

Phone

(929) 949-3134

Fax

(929) 929-1476

NPI assigned

Sep 6, 2018

Last updated

Aug 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Neighborhood Psychiatric Associates of Manhattan PLLC

  dba Sol Mental Health

  • Psychiatry Physician
  • New York, NY
  • NPI 1831576735

  Psychiatric/Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1619459518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13729 TAB DR",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354751694",
            "telephone_number": "662-312-2258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13729 TAB DR",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354751694",
            "telephone_number": "929-949-3134",
            "fax_number": "929-929-1476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 W 14th St Ste 506",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100117403",
            "country_code": "US",
            "telephone_number": "929-777-0173",
            "fax_number": "877-929-2508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "OCTAVIA",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-06",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-142018",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "o.ingram@neighbprhoodpsychiatry.com",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "39 W 14th St Ste 506",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100117403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@serenitymindbodypsych.com",
            "affiliation": "N",
            "endpointDescription": "Company Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Appointments /Messaging",
            "address_1": "13729 Tab Dr",
            "city": "Northport",
            "state": "AL",
            "country_code": "US",
            "postal_code": "354751694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kerry Rushing Hyche, RN
• Bryan Anthony Hypolite
• Iduna Healthcare Services PLLC
• Indian Hills Plastic Surgery PC
• Infectious Disease&Allergy
• Innovative Health Practice Center, LLC
• Brock Isom
• Raychelle Ivie, CPHT
• Alicia Ladonna Jackson, PT
• David B Jackson, MD

• Psychiatric/Mental Health Nurse Practitioner in Northport, AL
• Providers in Northport, AL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.