Healthcare Provider Details

I. General information

NPI: 1417867201
Provider Name (Legal Business Name): MARSHA RENAE ODELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 354
AFTON OK
74331-0354
US

IV. Provider business mailing address

23275 S HIGHWAY 69
AFTON OK
74331-3115
US

V. Phone/Fax

Practice location:
  • Phone: 918-944-3329
  • Fax:
Mailing address:
  • Phone: 918-944-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number231447
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: