Provider Demographics
NPI:1477073393
Name:ODOM, SONDRA DENISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:DENISE
Last Name:ODOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6347 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MS
Mailing Address - Zip Code:39320-9301
Mailing Address - Country:US
Mailing Address - Phone:601-917-7904
Mailing Address - Fax:
Practice Address - Street 1:6347 RED OAK DRIVE
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:MS
Practice Address - Zip Code:39320
Practice Address - Country:US
Practice Address - Phone:601-917-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902049363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care