Provider Demographics
NPI:1144831223
Name:ODOM, HALEY RAYETTE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:RAYETTE
Last Name:ODOM
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4666
Mailing Address - Country:US
Mailing Address - Phone:409-212-8111
Mailing Address - Fax:
Practice Address - Street 1:740 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4666
Practice Address - Country:US
Practice Address - Phone:409-212-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily