Healthcare Provider Details

I. General information

NPI: 1407341142
Provider Name (Legal Business Name): OSEKPAMEN WICKLIFFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST STE LL
TULSA OK
74135-5013
US

IV. Provider business mailing address

5310 E 31ST ST STE LL
TULSA OK
74135-5013
US

V. Phone/Fax

Practice location:
  • Phone: 918-236-4000
  • Fax: 918-236-4001
Mailing address:
  • Phone: 918-236-4000
  • Fax: 918-236-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number38402
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: