Provider Demographics
NPI:1902185663
Name:HAMILTON, ODESSA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:ODESSA
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3127
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:950 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:47353-8496
Practice Address - Country:US
Practice Address - Phone:765-458-5191
Practice Address - Fax:765-458-7301
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2013-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28170007A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201038750Medicaid
000000736285OtherANTHEM
INM400056491Medicare PIN