Healthcare Provider Details

I. General information

NPI: 1689013005
Provider Name (Legal Business Name): JESSICA MARIE FAZENDIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE BARTELT M.D.

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 11/27/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 4G
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5789
  • Fax: 405-271-1643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number38362
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number45139
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: