Provider Demographics
NPI:1235724907
Name:ODELL, MELODY ALICE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ALICE
Last Name:ODELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 DOCTOR M ROPER PKWY N
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-5117
Mailing Address - Country:US
Mailing Address - Phone:903-894-3991
Mailing Address - Fax:
Practice Address - Street 1:435 DOCTOR M ROPER PKWY N
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757-5117
Practice Address - Country:US
Practice Address - Phone:903-894-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029241363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner