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General NPI Number Information
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NPI Number | 1851056758
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Entity Type | Individual
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Provider Name | LANDON JAMES NAULT PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 900 W CHEROKEE AVE
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City | ENID
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State | OK
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Zip | 73701-5410
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Country | US
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Telephone | 580-233-6707
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Fax | 580-233-3724
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Provider Business Mailing Address
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Address Line | 1101 SAWGRASS LN
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City | ENID
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State | OK
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Zip | 73703-7056
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Country | US
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Telephone | 405-368-5852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4667
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4667
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4667
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License Number State | OK
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