Healthcare Provider Details

I. General information

NPI: 1972965689
Provider Name (Legal Business Name): BRITTANY KALISSE ODOM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MEDICAL CENTER DR
WEST POINT MS
39773-0430
US

IV. Provider business mailing address

63 MEDICAL CENTER DR
WEST POINT MS
39773-0430
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-1620
  • Fax: 662-494-0375
Mailing address:
  • Phone: 662-494-1620
  • Fax: 662-494-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-152382
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2022-0892
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33590
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: