Provider Demographics
NPI:1477588457
Name:ODELL, WENDY KAY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:KAY
Last Name:ODELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:KAY
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 COUNTY ROAD 1953
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-3916
Mailing Address - Country:US
Mailing Address - Phone:903-383-7445
Mailing Address - Fax:903-383-7446
Practice Address - Street 1:5327 N CENTRAL EXPY STE 200
Practice Address - Street 2:IV ANESTHESIA
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3345
Practice Address - Country:US
Practice Address - Phone:214-520-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN589065367500000X
TX052987367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162479302Medicaid
TX85063UOtherBLUE CROSS BLUE SHIELD
TX85063UOtherBLUE CROSS BLUE SHIELD