Healthcare Provider Details

I. General information

NPI: 1013513589
Provider Name (Legal Business Name): LAURA ODLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 AIRPORT RD STE B
HOT SPRINGS AR
71913-8069
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-767-0075
  • Fax: 501-760-2739
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213646
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: