MEDICARE: LINDSEY MARIE ODESSA NP-C

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	RN257871	GA

General Provider Information

NPI Number	:	1427657584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY MARIE ODESSA NP-C

Provider Business Mailing Address
First Line	:	623 S HOUSTON LAKE RD STE 200
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-9094
Country	:	US
Telephone Number	:	478-923-4403
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 S HOUSTON LAKE RD STE 200
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-9094
Country	:	US
Telephone Number	:	478-923-4403
Fax Number	:

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

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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