Provider Demographics
NPI:1134486483
Name:ODIE, TEFFANY (RN)
Entity Type:Individual
Prefix:
First Name:TEFFANY
Middle Name:
Last Name:ODIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 VALLEYCREEK RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-2353
Mailing Address - Country:US
Mailing Address - Phone:214-272-9701
Mailing Address - Fax:214-272-9701
Practice Address - Street 1:815 VALLEYCREEK RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-2353
Practice Address - Country:US
Practice Address - Phone:214-272-9701
Practice Address - Fax:214-272-9701
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX769439163W00000X, 163WH0200X, 163WH1000X, 163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0000XNursing Service ProvidersRegistered NursePain Management