Andrew Tyler Odom, BS

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

9196 W Emerald St Ste 135
Boise, ID 83704-8004

Phone

(208) 323-4400

NPI assigned

Jun 12, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Andrew T Odom Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1992143960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9196 W EMERALD ST STE 135",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048004",
            "telephone_number": "208-323-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9196 W EMERALD ST STE 135",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048004",
            "telephone_number": "208-323-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "ANDREW",
        "middle_name": "TYLER",
        "name_prefix": "Mr.",
        "credential": "BS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREW",
            "last_name": "ODOM",
            "middle_name": "T",
            "credential": "BS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Occupational Health Centers of Idaho LLC
• Lindsey Elizabeth Ochoa, PA-C
• Bridget Oconnell
• Monisha Oconnor
• Stephen Odell, CRNA
• Carl Irwin Odom, MD
• Casandra Odoms
• Murry Odonnell
• Meghan Oeding, LAT, ATC
• Richard Keith Oehlschlager, M.D.

• Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.