Provider Demographics
NPI:1720295660
Name:O'DELL, JENNIFER P (ACNP, BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:O'DELL
Suffix:
Gender:F
Credentials:ACNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6584 POPLAR AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-0620
Mailing Address - Country:US
Mailing Address - Phone:901-519-4690
Mailing Address - Fax:901-519-4691
Practice Address - Street 1:6584 POPLAR AVE STE 102
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-0620
Practice Address - Country:US
Practice Address - Phone:901-519-4690
Practice Address - Fax:901-519-4691
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12694363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care