Provider Demographics
NPI:1245909928
Name:O'DELL, KRISTEN DAVIDSON (NP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DAVIDSON
Last Name:O'DELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 PIPER HILL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1661
Mailing Address - Country:US
Mailing Address - Phone:636-442-5035
Mailing Address - Fax:636-442-5036
Practice Address - Street 1:114 PIPER HILL DR STE 103
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1661
Practice Address - Country:US
Practice Address - Phone:636-442-5035
Practice Address - Fax:636-442-5036
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ196098363L00000X
MO2025038536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner