Healthcare Provider Details

I. General information

NPI: 1679711550
Provider Name (Legal Business Name): KRISTEN MICHELLE ODELL N.D. , PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 S RIVER RD UNIT 4
BEDFORD NH
03110-6934
US

IV. Provider business mailing address

115 N OHIO AVE
LONG BEACH TOWNSHIP NJ
08008-2858
US

V. Phone/Fax

Practice location:
  • Phone: 603-660-9677
  • Fax:
Mailing address:
  • Phone: 603-660-9677
  • Fax: 603-294-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00986300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number69
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: