Provider Demographics
NPI:1457843724
Name:ODDO, ERIN NICHOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICHOLE
Last Name:ODDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W LOUIS HENNA BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2569
Mailing Address - Country:US
Mailing Address - Phone:512-248-7000
Mailing Address - Fax:
Practice Address - Street 1:1201 W LOUIS HENNA BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78681-2569
Practice Address - Country:US
Practice Address - Phone:512-248-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12289363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program