# MS. AMANDA KAYE ODOM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1972648038
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA 1017 | OK | Yes |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 08/30/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1357924680 | — | OK |