Provider Demographics
NPI:1366481558
Name:CLICK, JAMES NELSON (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:NELSON
Last Name:CLICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 BROADWAY EXTENSION
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114
Mailing Address - Country:US
Mailing Address - Phone:405-419-5412
Mailing Address - Fax:405-419-5468
Practice Address - Street 1:9800 BROADWAY EXTENSION
Practice Address - Street 2:SUITE 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-419-5412
Practice Address - Fax:405-419-5468
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200251230AMedicaid
TXP26350Medicare UPIN