Individual
TRACY ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
101 E PAULK AVE STE A, OPP, AL 36467-1727
(334) 493-0311
(334) 493-0355
Mailing address
PO BOX 342, FLORALA, AL 36442-0342
(334) 809-8049
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-111973
AL
364SF0001X
Family Health Clinical Nurse Specialist
1-111973
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305045
—
AL
Enumeration date
12/21/2017
Last updated
04/04/2025
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