Individual provider Active NPI

Jennifer Elaine O'Dell, FNP-C

  • Family Nurse Practitioner
  • Ooltewah, TN
National Provider Identifier
1407610090
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
35703 Issued in TN
Practice address
6059 Arbury Way Unit 101
Ooltewah, TN 37363-5001
Phone
(423) 238-8880
NPI assigned
Feb 13, 2024
Last updated
Mar 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 35703 TN Primary

Addresses

Primary practice location

6059 Arbury Way Unit 101
Ooltewah, TN 37363-5001

Mailing address

6059 Arbury Way # 101
Ooltewah, TN 37363-5001
Phone (423) 238-8880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240307002976 TN Practitioner - Nurse Practitioner 5294171609 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Bradley Physician Services, LLCGroup PAC ID 8123563392, 77 clinicians

Practice addresses (Care Compare)

6059 Arbury Way
Suite 101
Ooltewah, TN 37363-5001
Phone (423) 238-8880

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
35703TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bradley Physician Services, LLC Family CurrentSince Aug 1, 2024 Accepting new patients

Locations

2700 Westside Dr NW
Ste 204
Cleveland, TN 37312
Phone (423) 476-3711

6059 Arbury Way
#101
Ooltewah, TN 37363
Phone (423) 238-8880

Interoperability endpoints

  • Direct secure messaging: jennifer.o.dell.1@31613.direct.athenahealth.com

Organizations & group practices 2

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1407610090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6059 ARBURY WAY # 101",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373635001",
            "telephone_number": "423-238-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6059 ARBURY WAY UNIT 101",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373635001",
            "telephone_number": "423-238-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DELL",
        "first_name": "JENNIFER",
        "middle_name": "ELAINE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "35703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ooltewah, TN

Sources for this page

Verify at the official NPI Registry.