Healthcare Provider Details

I. General information

NPI: 1104890870
Provider Name (Legal Business Name): TIMOTHY SHAWN ODELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/06/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HEALTH PARK DRIVE
HENDERSONVILLE NC
28792
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 828-274-7367
  • Fax: 828-998-9056
Mailing address:
  • Phone:
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberA777NS
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1014895
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: