=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154382828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BYRAN WESSON ACNS-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 N HARVARD AVE STE. E
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74115-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-832-6049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 S WHEELING AVE SUITE 606
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74104-5638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-748-7676
-----------------------------------------------------
Fax | 918-293-3130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | R0034908
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 74810
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 364SE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Clinical Nurse Specialist
-----------------------------------------------------
License Number | R0034808
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------