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General NPI Number Information
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NPI Number | 1184983744
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Entity Type | Individual
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Provider Name | JEFFERSON MBENGA FNP
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 2828 NW 57TH ST STE 304
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7070
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Country | US
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Telephone | 405-418-4777
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Fax | 405-745-4515
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Provider Business Mailing Address
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Address Line | 2828 NW 57TH ST STE 304
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7070
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Country | US
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Telephone | 405-418-4777
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Fax | 405-753-4515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 217427
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License Number State | OK
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