Active NPI
Nakita Richelle Odom, LCSW
- Social Worker
- Memphis, TN
National Provider Identifier
1407592637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 13362
- Practice address
- 1030 Jefferson Ave
Memphis, TN 38104-2127 - Phone
- (901) 523-8990
- NPI assigned
- May 10, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 9492 | TN | |
| Social Worker | 104100000X | 13362 | TN | Primary |
Addresses
Primary practice location
1030 Jefferson Ave
Memphis, TN 38104-2127
Mailing address
2510 Marion LN
Southaven, MS 38672-2325
Phone (731) 803-4581
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9492 | TN | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732147200000",
"number": "1407592637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2510 MARION LN",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386722325",
"telephone_number": "731-803-4581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 JEFFERSON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381042127",
"telephone_number": "901-523-8990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "NAKITA",
"middle_name": "RICHELLE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-10",
"last_updated": "2024-11-21",
"certification_date": "2024-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "9492",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "13362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.