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Contact Information

RAYNELL R ODOM, NP
4303 VANCE JACKSON
SAN ANTONIO, TX78230
 Phone: 210-579-3800
 Fax: 210-341-9682
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for RAYNELL R ODOM · (Female)

NPI # 1013071448
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 12/20/2006
Last updated 02/08/2017 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • TX License # 502431
  • TX Other 12252309 CAQH
  • TX Other 349036ZGL0 GROUP PTAN
Hospital affiliation(s)
  • CONNALLY MEMORIAL MEDICAL CENTER - (Acute Care)
    499 10TH STREET
    FLORESVILLE, TX 78114
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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