Provider Demographics
NPI:1356108054
Name:O'DONNELL, LAURA EVANGELINE BAREFOOT (RN, CMGT-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:EVANGELINE BAREFOOT
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:RN, CMGT-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:EVANGELINE
Other - Last Name:BAREFOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NREMT
Mailing Address - Street 1:3132 CARRIE TAYLOR CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1446
Mailing Address - Country:US
Mailing Address - Phone:931-249-9225
Mailing Address - Fax:
Practice Address - Street 1:6102 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5940
Practice Address - Country:US
Practice Address - Phone:270-412-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX841048163W00000X
TX2018081462163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse