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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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CAID-JEFFERSON, MANDY RENEE       
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.
Practice Address: OKLAHOMA STATE DEPT OF HEALTH WIC SERVICE
123 ROBERT S. KERR AVE. SUITE 1702
OKLAHOMA CITY OK 73102-6406

Address last updated on 10/2/2024
Phone #: (405) 426-8522
Fax #: (405) 900-7576
County: OKLAHOMA
License: 1447
Dated: 6/23/2006
Expires: 10/31/2025
Temp. Ltr. Issued: 6/8/2006
Temp. Ltr. Expires: 6/24/2006
License Type: Licensed Dietitian
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 0
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
OKLAHOMA STATE DEPT OF HEALTH WIC SERVICE
123 ROBERT S. KERR AVE. SUITE 1702
OKLAHOMA CITY OK 73102-6406

Phone #: (405) 426-8522
Fax #: (405) 900-7576

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