Provider Demographics
NPI:1790075224
Name:TIMMS, JAMES LUIE JR (LPN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LUIE
Last Name:TIMMS
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RYAN
Mailing Address - State:OK
Mailing Address - Zip Code:73565-5500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1409 7TH ST
Practice Address - Street 2:
Practice Address - City:RYAN
Practice Address - State:OK
Practice Address - Zip Code:73565-5500
Practice Address - Country:US
Practice Address - Phone:580-467-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK005159164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse