Provider Demographics
NPI:1407341142
Name:WICKLIFFE, OSEKPAMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:OSEKPAMEN
Middle Name:
Last Name:WICKLIFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 E 31ST ST STE LL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5013
Mailing Address - Country:US
Mailing Address - Phone:918-236-4000
Mailing Address - Fax:918-236-4001
Practice Address - Street 1:5310 E 31ST ST STE LL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5013
Practice Address - Country:US
Practice Address - Phone:918-236-4000
Practice Address - Fax:918-236-4001
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK384022084P0804X
MO20180224802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry