Selene Ingraham is a Family Nurse Practitioner practicing in Provo, Utah. The National Provider Identifier (NPI) is #1780577189, which was assigned on June 3, 2025, and the registration record was last updated on June 20, 2025. The practitioner's main practice location is at 1055 N 500 W, Ste 201 Bldg C, Provo, UT 84604; the contact telephone number is 8014298000, and the fax number is 8014298150. The primary taxonomy of Selene Ingraham is Family Nurse Practitioner (363LF0000X), with specialization in Family. Selene Ingraham is licensed to practice in the state of Utah (#8513908-4405).
| NPI | 1780577189 |
| Entity Type | Individual |
| Provider Name | SELENE INGRAHAM |
| Gender | Female |
| Credential | APRN |
| Practice Address |
1055 N 500 W Ste 201 Bldg C Provo UT 84604 |
| Practice Telephone | 8014298000 |
| Practice Fax Number | 8014298150 |
| Mailing Address |
1055 N 500 W Attn Credentialing Provo UT 84604 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Certification Date | 2025-06-20 |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2025-06-20 |
| Is Sole Proprietor | Y |
| PAC ID |
4385158815 Medicare Provider Enrollment and Chain/Ownership System (PECOS) Associate Control (PAC) ID |
| Full Name | SELENE INGRAHAM |
| Primary Specialty | NURSE PRACTITIONER |
| Address |
5546 W Saguaro Dr West Jordan UT 84081-4392 |
| Primary | Code | Classification | Specialization | Taxonomy Group | License Number | License State |
|---|---|---|---|---|---|---|
| Y | 363LF0000X | Nurse Practitioner | Family | 8513908-4405 | UT |
| Address | Telephone | Fax |
|---|---|---|
| 221 S 2800 E, Spanish Fork, UT 846606514 | 8016694656 |
| Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Definition: Definition to come... |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Trisha S Abraham · Trisha Sam Joseph | 385 Morris Ave, Springfield, NJ 07081-1151 | Family Nurse Practitioner | 2025-09-06 |
| Melanie J Schroyer | 2000 West St, Munhall, PA 15120-2540 | Family Nurse Practitioner | 2025-09-06 |
| Jason Ryan Ridenour | 5160 E Southport Rd, Indianapolis, IN 46237-9601 | Family Nurse Practitioner | 2025-09-05 |
| Hellen M Mogire | 377 Jersey Ave Ste 590, Jersey City, NJ 07302-4691 | Family Nurse Practitioner | 2025-09-06 |
| Rebekah Cannon | 426 S Wall St, Calhoun, GA 30701-2432 | Family Nurse Practitioner | 2025-09-05 |
| Di Feng | 13768 Roswell Ave Ste 118, Chino, CA 91710-1402 | Family Nurse Practitioner | 2025-09-06 |
| Pierre Antoine Dervil | 1386 Sw Granville Ave, Port Saint Lucie, FL 34953-2201 | Family Nurse Practitioner | 2025-09-06 |
| Taquoya Williams | 1113 Evergreen Ave, Douglas, GA 31533-1822 | Family Nurse Practitioner | 2025-09-06 |
| Mary Alina Abbott | 3317 Shorecliff Dr Ne, Tacoma, WA 98422-2302 | Family Nurse Practitioner | 2025-09-06 |
| Janet Adriana Fernandez Quesada | 1206 S Douglas Rd Apt 3, Coral Gables, FL 33134-3443 | Family Nurse Practitioner | 2025-09-06 |
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| Street Address |
1055 N 500 W STE 201 BLDG C |
| City | PROVO |
| State | UT |
| Zip Code | 84604 |
| Country | US |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Revere Health PC | 1055 N 500 W, Provo, UT 84604-3305 | Multi-Specialty Clinic/Center | 2006-05-09 |
| Diane Nguyen | 1055 N 500 W, Ste 212 Bldg C, Provo, UT 84604 | Student in an Organized Health Care Education/Training Program | 2022-03-03 |
| Paul S Rosser | 1055 N 500 W, Ste 100, Bldg B, Provo, UT 84604-3305 | Adult Health Nurse Practitioner | 2006-08-19 |
| Elsie Carpenter | 1055 N 500 W, Bldg A, Provo, UT 84604-3305 | Physician Assistant | 2025-03-20 |
| Rebekah Tai Platt | 1055 N 500 W Bldg A, Provo, UT 84604-3305 | Family Nurse Practitioner | 2025-08-07 |
| Wyatt James Boles | 1055 N 500 W, Bldg A, Provo, UT 84604 | Family Medicine Physician | 2018-07-17 |
| Fred Jeston Dawson | 1055 N 500 W, Suite 112, Provo, UT 84604-3305 | Diagnostic Radiology Physician | 2008-06-06 |
| Sarah Marie Andrews · Sarah Marie Smith | 1055 N 500 W Bldg A, Provo, UT 84604-3305 | Family Medicine Physician | 2010-04-16 |
| Crystal C Huffaker · Crystal C Johnson | 1055 N 500 W, Ste 211, Building C, Provo, UT 84604-3305 | Family Nurse Practitioner | 2008-11-19 |
| John K Staheli | 1055 N 500 W, Suite 212, Provo, UT 84604-3305 | Internal Medicine Physician | 2006-05-03 |
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| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Valley Mobile Wound Care PLLC | 1288 Devonshire Dr., Provo, UT 84604 | Acute Care Nurse Practitioner | 2025-01-15 |
| Mark Wilson Thomas | 1034 N 500 W, Provo, UT 84604 | Anesthesiology Physician | 2012-05-25 |
| Philip D Groesbeck | 1034 North 500 West, Utah Valley Regional Medical Center, Provo, UT 84604 | Anesthesiology Physician | 2006-10-03 |
| Emma Lund | 1806 N 1120 W, Provo, UT 84604-1179 | Physical Therapist | 2025-05-29 |
| Alyssa Castro | 1868 N 1120 W, Provo, UT 84604-1179 | Mental Health Counselor | 2025-02-27 |
| Maxwell Heyborne | 1190 N 900 E, Provo, UT 84604 | Student in an Organized Health Care Education/Training Program | 2025-07-14 |
| Sean Martin Lamb | 1896 N 1120 W, Provo, UT 84604-1179 | Addiction (Substance Use Disorder) Counselor | 2016-05-02 |
| Alec Devlyn Barrow | 1021 Fir Avenue, Provo, UT 84604 | Mental Health Counselor | 2019-11-01 |
| Susanna Bean West · Susana Bean | 320 River Park Dr Ste 125, Provo, UT 84604 | Certified Registered Nurse Anesthetist | 2005-12-29 |
| Enlightened Path PLLC | 1881 N 1120 W, Provo, UT 84604-1180 | Adolescent and Children Mental Health Clinic/Center | 2025-07-29 |
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| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Ashley Ingraham | 605 Standiford Ave Ste B, Modesto, CA 95350-1000 | Behavior Technician | 2025-03-11 |
| Jennifer Hawthorne Ingraham | 4501 Cameron Valley Pkwy Ste 300, Charlotte, NC 28211-4368 | Registered Dietitian | 2025-01-07 |
| Maria Selene Castorena Ayon | 13001 Ramona Blvd, Ste I, Irwindale, CA 91706-3752 | Case Manager/Care Coordinator | 2016-06-15 |
| Megan Elizabeth Ingraham | 1009 Montgomery Ave, Norristown, PA 19403 | Psychologist | 2023-06-26 |
| Justin Ingraham | 3665 S 8400 W, Magna, UT 84044-4907 | Family Nurse Practitioner | 2025-02-17 |
| Selene Clarissa Koo | 262 Danny Thomas Pl, Memphis, TN 38105-3678 | Anatomic Pathology & Clinical Pathology Physician | 2011-06-21 |
| Amy Ingraham | 13121 Atlantic Blvd Ste 200, Jacksonville, FL 32225-0102 | Behavior Technician | 2023-01-03 |
| Selene Nuno | 23909 W Renwick Rd Ste 105, Plainfield, IL 60544-2109 | Behavioral Analyst | 2024-10-11 |
| Robert Quinn Ingraham II | 5201 Northshore Dr, Ste 100, North Little Rock, AR 72118 | Neurological Surgery Physician | 2006-01-19 |
| Hannah Marie Ingraham | 2732 Grand Ave Ste 101, Everett, WA 98201-3416 | Addiction (Substance Use Disorder) Counselor | 2025-02-12 |
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This dataset includes over five million health care providers who are assigned National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare & Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under Health Insurance Portability and Accountability Act (HIPAA). Each provider is registered with the NPI, full name, status, address, taxonomy, other identifiers, etc.
| Subject | Transparency and Disclosure |
| Jurisdiction | Federal |
| Data Provider | National Plan and Provider Enumeration System (NPPES), by the Centers for Medicare & Medicaid Services (CMS) |
| Source | download.cms.gov |
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers and all health plans and health care clearinghouses, who must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). All health care providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI. A HIPAA-covered entity is a health care provider that conducts certain transactions in electronic form, or a health care clearinghouse, or a health plan (including commercial plans, Medicare, and Medicaid). Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008. This dataset includes over five million health care providers (individuals and organizations) who are assigned NPI. The provider data elements are disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA), as listed in the NPPES Data Dissemination Notice (CMS-6060-N). The NPI final rules define the following elements which required to be disclosed as determined by Department of Health & Human Services (HHS): NPI, Entity Type, Provider Name, Credential, Business Mailing Address, Business Location Address, Healthcare Provider Taxonomy Code, Other Provider Identifier, Provider Enumeration Date, NPI Deactivation Date, Provider License Number, Authorized Official Name and Contact Information. |