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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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MALLORY, JULIE ANN       
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: 31413 HIGHWAY NINE
TECUMSEH OK 74873-5523

Address last updated on 9/17/2024
Phone #: (405) 205-0935
Fax #:
County: OKLAHOMA
License: 693
Dated: 1/11/1992
Expires: 10/31/2025
Temp. Ltr. Issued: 10/3/1991
Temp. Ltr. Expires: 1/11/1992
License Type: Licensed Dietitian
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year:
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:
31413 HIGHWAY NINE
TECUMSEH OK 74873-5523

Phone #: (405) 205-0935
Fax #:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
DESTINY NOEL HOWARD PD 696
AISA M TRICE PD 712

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