Provider Demographics
NPI:1679122071
Name:ODISHO, JODY HINTON (APN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:HINTON
Last Name:ODISHO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:M
Other - Last Name:HINRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-977-5534
Practice Address - Fax:865-981-2154
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily