Provider Demographics
NPI:1699038174
Name:KAMANI, ODELLE TSAYA (NP)
Entity Type:Individual
Prefix:
First Name:ODELLE
Middle Name:TSAYA
Last Name:KAMANI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ODELLE
Other - Middle Name:K
Other - Last Name:NKAMGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5001 SPRING VALLEY ROAD
Mailing Address - Street 2:SUITE 600 EAST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3946
Mailing Address - Country:US
Mailing Address - Phone:214-365-6100
Mailing Address - Fax:214-365-6150
Practice Address - Street 1:1320 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6912
Practice Address - Country:US
Practice Address - Phone:202-610-1886
Practice Address - Fax:202-610-1887
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1025467363LF0000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No374U00000XNursing Service Related ProvidersHome Health Aide