Provider Demographics
NPI:1881066421
Name:ODELL, AISHA (PA)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W 20TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2429
Mailing Address - Country:US
Mailing Address - Phone:713-802-1300
Mailing Address - Fax:713-802-9107
Practice Address - Street 1:427 W 20TH ST STE 302
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2429
Practice Address - Country:US
Practice Address - Phone:713-802-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant