Provider Demographics
NPI:1609411263
Name:ODOM, HOPE ELIZABETH
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:ELIZABETH
Last Name:ODOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CRESCENT POINTE PKWY APT 4108
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7396
Mailing Address - Country:US
Mailing Address - Phone:979-204-3987
Mailing Address - Fax:
Practice Address - Street 1:2911 TEXAS AVE S STE 202
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5388
Practice Address - Country:US
Practice Address - Phone:979-695-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143434363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care