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ELLIS, JERI LYNN
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This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
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| Practice Address: |
420 N. KICKAPOO
SHAWNEE OK 74804
Address last updated on 2/2/2018 |
| Phone #: |
(405) 273-9327 |
| Fax #: |
(405) 273-9300 |
| County: |
POTTAWATOMIE |
| License: |
20048 |
| Dated: |
2/24/1997 |
| Expires: |
2/1/2018 |
| License Type: |
Medical Doctor |
| Specialty: |
General Practice
Occupational Medicine |
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| Status: |
Inactive |
| Status Class: |
Deceased |
| Restricted to: |
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| Registered to Dispense: |
YES |
| Medical School: |
D Geffen Sch of Med-UCLA, Los Angeles CA 90095 |
| Graduated: |
6 /
1989 |
| CME Year: |
2019 |
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Pending and/or Past Disciplinary Actions:
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| Date |
Action |
Reasons |
Remarks |
| 1/8/2018 |
Complaint Citation |
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| #1/1/1900# |
Past Disciplinary Action |
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Board Filings and/or Orders:
01/31/2018
01/08/2018
01/08/2018
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
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| New Patients: |
No |
| Medicaid: |
No |
| Medicare: |
No |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
None listed |
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