Provider Demographics
NPI:1437472115
Name:ODOM, DEBORAH CARROLL (RN, ACNP)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:CARROLL
Last Name:ODOM
Suffix:
Gender:F
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 MIDDLE TENNESSEE BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-7844
Mailing Address - Country:US
Mailing Address - Phone:615-893-1615
Mailing Address - Fax:
Practice Address - Street 1:2809 MIDDLE TENNESSEE BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-7844
Practice Address - Country:US
Practice Address - Phone:615-893-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014662363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care