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General NPI Number Information
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NPI Number | 1538727078
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Entity Type | Individual
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Provider Name | PATRICK KIRK O'DELL FNP
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Gender | Male
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 191 IOWA BLVD
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City | TRENTON
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State | MO
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Zip | 64683-8343
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Country | US
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Telephone | 816-632-1390
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Fax |
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Provider Business Mailing Address
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Address Line | 511 W 4TH STREET TER
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City | CARROLLTON
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State | MO
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Zip | 64633-1420
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Country | US
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Telephone | 660-322-5035
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2017040279
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License Number State | MO
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