| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JENNIFER NICOLE ODOM | 1255761938 | 2023-11-10 |
Jennifer Nicole Odom [F] graduated in 2019 and primarily specializes in Nurse Practitioner.
Jennifer Nicole Odom is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1255761938. Registration indicates Jennifer Nicole Odom is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Family, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Family, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Acute Care, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Acute Care, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 4385970730 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mrs. Jennifer Nicole Odom NP |
| Practice Office Address | 1613 N MCKENZIE ST FOLEY, AL US |
| Practice Office Telephone | 2519493710 |
| Practice Office Fax | 2519493715 |
| Mailing Address | 1613 N MCKENZIE ST FOLEY, AL 365352247 US |
| Business Telephone | 2519493479 |
| Business Fax | 2519493434 |
| Code | Practice | License No State |
|---|---|---|
| 363LF0000X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Family All Other Specialties & Provider Types Nurse Practitioner Family Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 1-133663
AL |
| 363LA2100X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Acute Care All Other Specialties & Provider Types Nurse Practitioner Acute Care Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 1-133663
AL |
| 363L00000X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner All Other Specialties & Provider Types Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers | 1-133663
AL |
| 03637799 | MEDICAID | MS | |
| 7100681410 | MEDICAID | KY | |
| 236578 | MEDICAID | AL |