Provider Demographics
NPI:1043905540
Name:ODUM, BRIANNA RHEA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:RHEA
Last Name:ODUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PROMENADE VISTA ST UNIT 4325
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2247
Mailing Address - Country:US
Mailing Address - Phone:276-613-1689
Mailing Address - Fax:
Practice Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3715
Practice Address - Country:US
Practice Address - Phone:864-442-4110
Practice Address - Fax:864-442-4126
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily