Provider Demographics
NPI:1487636007
Name:ODONNELL, HELEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:M
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BAYSHORE DR
Mailing Address - Street 2:UNIT G
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3574
Mailing Address - Country:US
Mailing Address - Phone:859-749-6638
Mailing Address - Fax:
Practice Address - Street 1:411 BAYSHORE DR
Practice Address - Street 2:UNIT G
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-3574
Practice Address - Country:US
Practice Address - Phone:859-749-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31061208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64310618Medicaid
KY000000306733OtherANTHEM
KY64310618Medicaid
KY64310618Medicaid