Healthcare Provider Details

I. General information

NPI: 1437440278
Provider Name (Legal Business Name): JESSICA ANN FAUGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N LEE AVE STE 200
OKLAHOMA CITY OK
73103
US

IV. Provider business mailing address

1110 N LEE AVE STE 200
OKLAHOMA CITY OK
73103-2612
US

V. Phone/Fax

Practice location:
  • Phone: 405-218-2530
  • Fax: 405-218-2569
Mailing address:
  • Phone: 405-218-2530
  • Fax: 405-218-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number37344
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number21125
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: