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  7. NPI Record 1750863726

AMY REBECCA ODOM NP
Complete NPI Record 1750863726
Nurse Practitioner - Gerontology in Mobile, AL


Quality Rating: 75.99 out of 100 score

NPI Status: Active since September 05, 2018

Contact Information

5955 AIRPORT BLVD
MOBILE, AL
ZIP 36608
Phone: (251) 633-0573
Fax: (251) 633-7367

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Healthcare Provider Taxonomy Code 2
  28. Provider License Number 2
  29. Provider License Number State Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Other Provider Identifier 1
  32. Other Provider Identifier Type Code 1
  33. Other Provider Identifier State 1
  34. Other Provider Identifier 2
  35. Other Provider Identifier Type Code 2
  36. Other Provider Identifier State 2
  37. Other Provider Identifier Issuer 2
  38. Other Provider Identifier 3
  39. Other Provider Identifier Type Code 3
  40. Other Provider Identifier State 3
  41. Other Provider Identifier Issuer 3
  42. Other Provider Identifier 4
  43. Other Provider Identifier Type Code 4
  44. Other Provider Identifier State 4
  45. Other Provider Identifier 5
  46. Other Provider Identifier Type Code 5
  47. Other Provider Identifier State 5
  48. Other Provider Identifier Issuer 5
  49. Other Provider Identifier 6
  50. Other Provider Identifier Type Code 6
  51. Other Provider Identifier State 6
  52. Other Provider Identifier Issuer 6
  53. Other Provider Identifier 7
  54. Other Provider Identifier Type Code 7
  55. Other Provider Identifier State 7
  56. Other Provider Identifier Issuer 7
  57. Other Provider Identifier 8
  58. Other Provider Identifier Type Code 8
  59. Other Provider Identifier State 8
  60. Other Provider Identifier Issuer 8
  61. Other Provider Identifier 9
  62. Other Provider Identifier Type Code 9
  63. Other Provider Identifier State 9
  64. Other Provider Identifier Issuer 9
  65. Other Provider Identifier 10
  66. Other Provider Identifier Type Code 10
  67. Other Provider Identifier State 10
  68. Other Provider Identifier 11
  69. Other Provider Identifier Type Code 11
  70. Other Provider Identifier State 11
  71. Other Provider Identifier 12
  72. Other Provider Identifier Type Code 12
  73. Other Provider Identifier State 12
  74. Other Provider Identifier 13
  75. Other Provider Identifier Type Code 13
  76. Other Provider Identifier State 13
  77. Other Provider Identifier 14
  78. Other Provider Identifier Type Code 14
  79. Other Provider Identifier State 14
  80. Other Provider Identifier Issuer 14
  81. Other Provider Identifier 15
  82. Other Provider Identifier Type Code 15
  83. Other Provider Identifier State 15
  84. Other Provider Identifier Issuer 15
  85. Other Provider Identifier 16
  86. Other Provider Identifier Type Code 16
  87. Other Provider Identifier State 16
  88. Other Provider Identifier Issuer 16
  89. Other Provider Identifier 17
  90. Other Provider Identifier Type Code 17
  91. Other Provider Identifier State 17
  92. Other Provider Identifier Issuer 17
  93. Is Sole Proprietor
  94. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1750863726. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750863726
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: AMY
The first name of the provider, if the provider is an individual.
Provider Middle Name: REBECCA
The middle name of the provider, if the provider is an individual.
Provider Credential Text: NP
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: PO BOX 7987
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: MOBILE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: AL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 366700987
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2516330573
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 5955 AIRPORT BLVD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MOBILE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: AL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 366083135
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2516330573
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2516337367
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/5/2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/23/2024
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 363LA2100X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 1-140750
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: AL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 363LG0600X
Provider License Number 2: 1-140750
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: AL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: Y
Other Provider Identifier 1: 224261
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: AL
Other Provider Identifier 2: 512-17406
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: AL
Other Provider Identifier Issuer 2: BCBS OF AL
Other Provider Identifier 3: A03845A
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: AL
Other Provider Identifier Issuer 3: MEDICARE
Other Provider Identifier 4: 225622
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: AL
Other Provider Identifier 5: 512-17405
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: AL
Other Provider Identifier Issuer 5: BCBS OF AL
Other Provider Identifier 6: 630799312
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: AL
Other Provider Identifier Issuer 6: HUMANA CHOICECARE
Other Provider Identifier 7: Z54984
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: AL
Other Provider Identifier Issuer 7: VIVA HEALTH
Other Provider Identifier 8: 6297709
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: AL
Other Provider Identifier Issuer 8: AETNA
Other Provider Identifier 9: P02140037
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: AL
Other Provider Identifier Issuer 9: RR MEDICARE
Other Provider Identifier 10: 05331824
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: MS
Other Provider Identifier 11: 223807
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: AL
Other Provider Identifier 12: 225017
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: AL
Other Provider Identifier 13: 225084
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: AL
Other Provider Identifier 14: 512-17400
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: AL
Other Provider Identifier Issuer 14: BCBS OF AL
Other Provider Identifier 15: 512-17403
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: AL
Other Provider Identifier Issuer 15: BCBS OF AL
Other Provider Identifier 16: 512-17404
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 16: AL
Other Provider Identifier Issuer 16: BCBS OF AL
Other Provider Identifier 17: 6906123
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 17: AL
Other Provider Identifier Issuer 17: UNITED HEALTHCARE
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 2/23/2024