Provider Demographics
NPI:1225579600
Name:ODELL, JESSICA RACHEL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RACHEL
Last Name:ODELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TIFFANY LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-3337
Mailing Address - Country:US
Mailing Address - Phone:423-366-3608
Mailing Address - Fax:
Practice Address - Street 1:26108 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7502
Practice Address - Country:US
Practice Address - Phone:276-477-4600
Practice Address - Fax:423-491-8109
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily