Provider Demographics
NPI:1306595335
Name:O'DELL, TRACI CHEEK (FNP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:CHEEK
Last Name:O'DELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0325
Mailing Address - Country:US
Mailing Address - Phone:336-789-2922
Mailing Address - Fax:336-789-0856
Practice Address - Street 1:105 N CRUTCHFIELD ST # 2
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8804
Practice Address - Country:US
Practice Address - Phone:336-789-2922
Practice Address - Fax:336-789-0856
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC240958163W00000X
NC5015985363L00000X, 363LF0000X
VA0024184233363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner