MEDICARE: MRS. LAURA ELIZABETH ODOM APRN, FNP-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	4256	SC

General Provider Information

NPI Number	:	1629385463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ELIZABETH ODOM APRN, FNP-C

Provider Business Mailing Address
First Line	:	5143 FOREST DR UNIT 200
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-5280
Country	:	US
Telephone Number	:	803-314-9120
Fax Number	:	803-314-9121

Provider Business Practice Location Address
First Line	:	5143 FOREST DR UNIT 200
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-5280
Country	:	US
Telephone Number	:	803-314-9120
Fax Number	:	803-314-9121

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

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	01/23/2026

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