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NPI Code Detail

MEDICARE: KRISTY L ODEN CRNP

MEDICARE: KRISTY L ODEN CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1-094352AL

General Provider Information

NPI Number : 1073623013
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY L ODEN CRNP
Provider Business Mailing Address
First Line : PO BOX 11407, DEPT# 5839
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35246-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1120 S JACKSON HWY STE 105
Second Line :
City : SHEFFIELD
State : AL
Zip : 35660-5770
Country : US
Telephone Number : 256-386-1125
Fax Number : 888-745-7084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 06/21/2024

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