Nicole Michelle Odom

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

108 Frederick Dr
Liverpool, NY 13088-6205

Phone

(315) 383-2416

NPI assigned

Jul 26, 2021

Reactivated

Oct 30, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761868800000",
    "number": "1033882113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 FREDERICK DR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886205",
            "telephone_number": "315-383-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 FREDERICK DR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130886205",
            "telephone_number": "315-383-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "NICOLE",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "deactivation_date": "2025-10-13",
        "reactivation_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karan O'Toole, R.N.
• John Gerard Obrien, MD
• Richard James Obrien, MPSPT
• Elizabeth Mary Oconnor, DDS
• Fuyuko Ikehara Oddy, D.C.
• Patrick Rafael Oellers, MD
• Stacy Oglesby
• Lara K. Ogundiran, NP
• Matthew S Ohern, MD
• Ifeanyi Victor Okwor, B.PHARM

• Case Manager/Care Coordinator in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Case Manager/Care Coordinator in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.