Individual
KEITH WAYNE ODENDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
7777 HENNESSY BLVD, SUITE1000, BATON ROUGE, LA 70808-4300
(225) 767-3900
(225) 214-9109
Mailing address
30 BURTON HILLS BLVD, STE 175, NASHVILLE, TN 37215-6403
(615) 988-2014
(615) 864-7565
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP03719
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1431940
—
LA
01
—
310063
WELLCARE
LA
01
—
P00712670
RAILROAD MCARE THRU PEPA
LA
Enumeration date
01/17/2006
Last updated
10/23/2024
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