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General NPI Number Information
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NPI Number | 1689665374
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Entity Type | Individual
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Provider Name | MISTY GAYLENE HORNSBY-ODOM FNP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 2306 RIDGE RD
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City | ROCKWALL
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State | TX
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Zip | 75087-5140
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Country | US
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Telephone | 972-771-8316
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Fax | 972-722-9214
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Provider Business Mailing Address
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Address Line | 110 THOROUGHBRED
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City | FATE
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State | TX
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Zip | 75087-6863
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Country | US
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Telephone | 469-323-0332
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 606499
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License Number State | TX
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