Healthcare Provider Details

I. General information

NPI: 1497676522
Provider Name (Legal Business Name): JESSICA SEIBOLD APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 2F
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

1200 CHILDRENS AVE STE 2F
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5530
  • Fax: 405-271-2263
Mailing address:
  • Phone: 405-271-5530
  • Fax: 405-271-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222409
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: