Provider Demographics
NPI:1154382828
Name:WESSON, JAMES BYRAN (ACNS-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BYRAN
Last Name:WESSON
Suffix:
Gender:M
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-748-7676
Mailing Address - Fax:918-293-3130
Practice Address - Street 1:1515 N HARVARD AVE
Practice Address - Street 2:STE. E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-4957
Practice Address - Country:US
Practice Address - Phone:918-832-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0034908364S00000X
KS74810364S00000X
OKR0034808364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124840AMedicaid
OK100124840AMedicaid
P16261Medicare UPIN
OK249228701Medicare ID - Type Unspecified