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General NPI Number Information
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NPI Number | 1104332527
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Entity Type | Individual
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Provider Name | TRACY ODOM CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 101 E PAULK AVE STE A
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City | OPP
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State | AL
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Zip | 36467-1727
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Country | US
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Telephone | 334-493-0311
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Fax | 334-493-0355
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Provider Business Mailing Address
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Address Line | PO BOX 342
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City | FLORALA
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State | AL
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Zip | 36442-0342
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Country | US
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Telephone | 334-809-8049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 1-111973
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-111973
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License Number State | AL
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