MEDICARE: MR. MICHAEL CHAD ODLE F.N.P.

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
1	363LF0000X	Family Nurse Practitioner	0000106893	TN

General Provider Information

NPI Number	:	1295722114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CHAD ODLE F.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38281-0307
Country	:	US
Telephone Number	:	731-885-8282
Fax Number	:	731-885-1998

Provider Business Practice Location Address
First Line	:	1229 S. FIRST STREET
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261
Country	:	US
Telephone Number	:	731-885-8282
Fax Number	:	731-885-1998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	11/01/2017

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