MEDICARE: JONELL KAY ODOM APRN

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	1227761	TX

General Provider Information

NPI Number	:	1538012471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONELL KAY ODOM APRN

Provider Business Mailing Address
First Line	:	20475 HIGHWAY 46 W STE 350
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6147
Country	:	US
Telephone Number	:	830-491-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	20475 HIGHWAY 46 W STE 350
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6147
Country	:	US
Telephone Number	:	830-491-4040
Fax Number	:

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

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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