| Doctor Name: | KENISHA ROSE INGRAM |
| NPI Number: | 1366825648 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1022166 |
| Business Practice Address: | 3216 Paumanok Way Sacramento, CA - 958352450 |
| Business Phone Number: | 9164707404 |
| Business Fax Number: | |
| Mailing Address: | 3216 Paumanok Way, SACRAMENTO |
| State: | CA |
| Postal Code: | 958352450 |
| Phone Number: | 9164707404 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2015 |
| NPI Last Update Date: | 07/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251E00000X |
| License Number: | 1022166 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Home Health |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |