MEDICARE: ODELLE TSAYA KAMANI NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R197787	MD
2	374U00000X	Home Health Aide
3	363LF0000X	Family Nurse Practitioner	RN1025467	DC
4	363LF0000X	Family Nurse Practitioner	R197787	MD

General Provider Information

NPI Number	:	1699038174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODELLE TSAYA KAMANI NP

Provider Business Mailing Address
First Line	:	5001 SPRING VALLEY RD STE 600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-3946
Country	:	US
Telephone Number	:	214-365-6100
Fax Number	:	214-365-6150

Provider Business Practice Location Address
First Line	:	1320 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6912
Country	:	US
Telephone Number	:	202-610-1886
Fax Number	:	202-610-1887

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

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	05/25/2026

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