Provider Demographics
NPI:1497859847
Name:O'DONNELL, STEPHANIE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DENISE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DENISE
Other - Last Name:REDDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6407 FM 39 N
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-4922
Mailing Address - Country:US
Mailing Address - Phone:903-903-1790
Mailing Address - Fax:848-213-0771
Practice Address - Street 1:6407 FM 39 N
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-4922
Practice Address - Country:US
Practice Address - Phone:254-426-8901
Practice Address - Fax:848-213-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI41395Medicare UPIN