Provider Demographics
NPI:1982422952
Name:ODIM, JONA (PMHNP)
Entity type:Individual
Prefix:
First Name:JONA
Middle Name:
Last Name:ODIM
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N COIT RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-6656
Mailing Address - Country:US
Mailing Address - Phone:469-949-4941
Mailing Address - Fax:469-942-9252
Practice Address - Street 1:1400 N COIT RD STE 202
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6656
Practice Address - Country:US
Practice Address - Phone:469-949-4941
Practice Address - Fax:469-942-9252
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024059804363LP0808X
NM84777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health