Provider Demographics
NPI:1851056758
Name:NAULT, LANDON JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:JAMES
Last Name:NAULT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:924 BROOKHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4204
Mailing Address - Country:US
Mailing Address - Phone:405-368-5852
Mailing Address - Fax:
Practice Address - Street 1:207 E F ST
Practice Address - Street 2:
Practice Address - City:OKEENE
Practice Address - State:OK
Practice Address - Zip Code:73763-9441
Practice Address - Country:US
Practice Address - Phone:580-822-4417
Practice Address - Fax:580-822-3018
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical