Healthcare Provider Details

I. General information

NPI: 1366481558
Provider Name (Legal Business Name): JAMES NELSON CLICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BROADWAY EXTENSION SUITE 203
OKLAHOMA CITY OK
73114
US

IV. Provider business mailing address

9800 BROADWAY EXTENSION SUITE 203
OKLAHOMA CITY OK
73114
US

V. Phone/Fax

Practice location:
  • Phone: 405-419-5412
  • Fax: 405-419-5468
Mailing address:
  • Phone: 405-419-5412
  • Fax: 405-419-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: