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General NPI Number Information
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NPI Number | 1871489393
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Entity Type | Individual
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Provider Name | BLAKE ODEN FNP, APRN
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Gender | Male
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 1501 LOUISVILLE AVE
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City | MONROE
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State | LA
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Zip | 71201-6025
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Country | US
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Telephone | 318-323-8451
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Fax |
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Provider Business Mailing Address
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Address Line | 813 WALLACE DEAN RD
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City | WEST MONROE
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State | LA
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Zip | 71291-7754
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Country | US
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Telephone | 318-237-2832
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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 | 217824
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License Number State | LA
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