Provider Demographics
NPI:1245590314
Name:FOXEN, JESSICA MIKI (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MIKI
Last Name:FOXEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MIKI
Other - Last Name:LANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-793-1188
Mailing Address - Fax:405-793-0492
Practice Address - Street 1:1401 SW 34TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3059
Practice Address - Country:US
Practice Address - Phone:405-793-1188
Practice Address - Fax:405-793-0492
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK29308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program