Individual
AMY REBECCA ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
1-140750
AL
363LG0600X
Gerontology Nurse Practitioner
Primary
1-140750
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05331824
—
MS
05
—
223807
—
AL
05
—
224261
—
AL
05
—
225017
—
AL
05
—
225084
—
AL
05
—
225622
—
AL
01
—
512-17400
BCBS OF AL
AL
01
—
512-17403
BCBS OF AL
AL
01
—
512-17404
BCBS OF AL
AL
01
—
512-17405
BCBS OF AL
AL
01
—
512-17406
BCBS OF AL
AL
01
—
6297709
AETNA
AL
01
—
630799312
HUMANA CHOICECARE
AL
01
—
6906123
UNITED HEALTHCARE
AL
01
—
A03845A
MEDICARE
AL
01
—
P02140037
RR MEDICARE
AL
01
—
Z54984
VIVA HEALTH
AL
Enumeration date
09/05/2018
Last updated
02/23/2024
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