Provider Demographics
NPI:1811529209
Name:JAMES, TERESA MELINDA (APRN CFNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MELINDA
Last Name:JAMES
Suffix:
Gender:F
Credentials:APRN CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:BRAGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74423-0348
Mailing Address - Country:US
Mailing Address - Phone:918-351-3431
Mailing Address - Fax:
Practice Address - Street 1:1317 S DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-7013
Practice Address - Country:US
Practice Address - Phone:918-401-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200901640AMedicaid
OK99271OtherOKLAHOMA BON