Jacqueline S Taylor Odonald, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

L3496 Issued in TX

Practice address

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766

Phone

(903) 614-3000

Fax

(903) 614-3525

NPI assigned

Nov 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• Jacqueline S Taylor Odonald Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cogent Healthcare of Texas, PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1992722953
  Medicare reassignment
• Sabine County Hospital District

  • General Acute Care Hospital
  • Hemphill, TX
  • NPI 1508862921
  NPD (past)
• Texas Em-I Medical Services, PA

  • Internal Medicine Physician
  • Greenville, TX
  • NPI 1699981720
  NPD (past)
• South Arkansas Physician Services LLC

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1427018704

  Internal Medicine

  NPD (past)
• Texarkana Galleria Oaks Diagnostic Center LLC

  • Internal Medicine Physician
  • Arkadelphia, AR
  • NPI 1942376611
  NPD (past)

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1275514929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR ODONALD",
        "first_name": "JACQUELINE",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L3496",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E2888",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5M000",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0092MN",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145436001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145871301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD3261",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "TAYLOR ODONALD",
            "middle_name": "S",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joshua Nelson Talley, D.M.D
• Rodger Dale Talley, DDS
• Tammie Flanagan Luthringer Physical Therapy and Wellness, LLC
• Jon A Tarpley, MD
• Carol A Tatum, ANP CNS
• Carly Taylor, OT
• Mylene Taylor, FNP-BC
• Kimberly Shawn Teer, M.S. CCC/SLP
• Teleoptometric Service TX, P.C.
• Temple Memorial Pediatric Center Inc.

• Internal Medicine Physician in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.