Healthcare Provider Details

I. General information

NPI: 1013831619
Provider Name (Legal Business Name): JADA CLAIR ODOM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 HIGHWAY 39 N
MERIDIAN MS
39301-1078
US

IV. Provider business mailing address

11050 ROAD 468
PHILADELPHIA MS
39350-5906
US

V. Phone/Fax

Practice location:
  • Phone: 601-385-9111
  • Fax:
Mailing address:
  • Phone: 601-701-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908585
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: