Healthcare Provider Details

I. General information

NPI: 1821779679
Provider Name (Legal Business Name): IBIENEBARI JESSICA BAKPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW EXPRESSWAY STE 500
OKLAHOMA CITY OK
73112-4492
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4589
  • Fax: 405-945-4381
Mailing address:
  • Phone: 405-945-4589
  • Fax: 405-945-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47380
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: