Provider Demographics
NPI:1427657584
Name:ODESSA, LINDSEY MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:ODESSA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 S HOUSTON LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9094
Mailing Address - Country:US
Mailing Address - Phone:478-923-4403
Mailing Address - Fax:
Practice Address - Street 1:623 S HOUSTON LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9094
Practice Address - Country:US
Practice Address - Phone:478-923-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN257871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily