Provider Demographics
NPI:1598495095
Name:ODOM, SARAH NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:ODOM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E GODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GODLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76044-3787
Mailing Address - Country:US
Mailing Address - Phone:682-289-0427
Mailing Address - Fax:817-202-3978
Practice Address - Street 1:109 E GODLEY AVE
Practice Address - Street 2:
Practice Address - City:GODLEY
Practice Address - State:TX
Practice Address - Zip Code:76044-3787
Practice Address - Country:US
Practice Address - Phone:682-289-0427
Practice Address - Fax:817-202-3978
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX822232163W00000X
TX1086306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse