Provider Demographics
NPI:1427043397
Name:ODEN, JACKIE KAY (RN APRN)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:KAY
Last Name:ODEN
Suffix:
Gender:F
Credentials:RN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LYNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2229
Mailing Address - Country:US
Mailing Address - Phone:402-434-3370
Mailing Address - Fax:402-489-0731
Practice Address - Street 1:220 LYNCREST DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2229
Practice Address - Country:US
Practice Address - Phone:402-434-3370
Practice Address - Fax:402-489-0731
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110259363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055126013Medicaid
NE47055126013Medicaid
276430Medicare ID - Type Unspecified