Provider Demographics
NPI:1770214066
Name:ODOM, KATHERINE OLIVIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:OLIVIA
Last Name:ODOM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 1ST AVE N
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1866
Mailing Address - Country:US
Mailing Address - Phone:205-545-5088
Mailing Address - Fax:
Practice Address - Street 1:235 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2118
Practice Address - Country:US
Practice Address - Phone:229-378-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN193955363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily