Provider Demographics
NPI:1689395543
Name:ODLE, KRISTIN LEANN
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:LEANN
Last Name:ODLE
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 1:109 THORN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3571
Mailing Address - Country:US
Mailing Address - Phone:304-992-6143
Mailing Address - Fax:304-431-2450
Practice Address - Street 1:109 THORN ST STE C
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3571
Practice Address - Country:US
Practice Address - Phone:304-992-6143
Practice Address - Fax:304-431-2450
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant