Active NPI
Kendyl Ingram, CSFA
- Surgical Assistant
- Pueblo, CO
National Provider Identifier
1962931071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- SA.0002224
- Practice address
- 2101 W 32ND St
Pueblo, CO 81008-1321 - Phone
- (719) 231-0177
- NPI assigned
- Jun 12, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | SA.0002224 | CO | Primary |
Addresses
Primary practice location
2101 W 32ND St
Pueblo, CO 81008-1321
Mailing address
2101 W 32ND St
Pueblo, CO 81008-1321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA.0002224 | CO | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498003200000",
"number": "1962931071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 W 32ND ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 W 32ND ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081321",
"telephone_number": "719-231-0177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "KENDYL",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-12",
"last_updated": "2017-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "CO",
"license": "SA.0002224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.