Healthcare Provider Details

I. General information

NPI: 1154382828
Provider Name (Legal Business Name): JAMES BYRAN WESSON ACNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N HARVARD AVE STE. E
TULSA OK
74115-4957
US

IV. Provider business mailing address

1919 S WHEELING AVE SUITE 606
TULSA OK
74104-5638
US

V. Phone/Fax

Practice location:
  • Phone: 918-832-6049
  • Fax:
Mailing address:
  • Phone: 918-748-7676
  • Fax: 918-293-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR0034908
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number74810
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberR0034808
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: