Provider Demographics
NPI:1568730125
Name:O'DELL, NATALIE K (BA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:K
Last Name:O'DELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-0239
Mailing Address - Country:US
Mailing Address - Phone:580-775-7529
Mailing Address - Fax:
Practice Address - Street 1:121 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030
Practice Address - Country:US
Practice Address - Phone:580-369-5080
Practice Address - Fax:580-369-2488
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049040Medicaid