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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

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WILSON, VIVIAN LAVERNE       
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: MARY MAHONEY MEMORIAL HEALTH CENTER
12716 N.E. 36TH STREET
P O BOX 30589
OKLAHOMA CITY OK 73140

Address last updated on 7/29/2024
Phone #: (405) 769-3301
Fax #: (405) 769-0290
County: OKLAHOMA
License: 11902
Dated: 8/11/1978
Expires: 8/1/2025
License Type: Medical Doctor
Specialty: Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Colorado Sch Of Med (frmly in Denver)
Graduated: / 1977
CME Year: 2027
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.
Certifications:
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna Elect Choice
Aetna HMO
Aetna Managed Choice
Aetna PPO
Beechstreet PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
BlueChoice PPO
BlueLincs HMO
CIGNA HMO
CommunityCare HMO, Inc
CommunityCare Senior HMO
Coventry Health Care National Network
HealthChoice
Medicare Blue
Pacificare Commercial HMO
PacifiCare of Oklahoma, Inc
Preferred Community Choice
Prudential Health Care Plan, Inc
Secure Horizons HMO
SoonerCare HMO
SoonerCare PPO
United Healthcare Choice
United Healthcare EPO
United Healthcare HMO
United Healthcare Options PPO
United Healthcare POS
Welcor/Sooner
Hospital Privileges: None listed
Locations: Hours: Languages:
MARY MAHONEY MEMORIAL HEALTH CENTER
12716 N.E. 36TH STREET
P O BOX 30589
OKLAHOMA CITY OK 73140

Phone #: (405) 769-3301
Fax #: (405) 769-0290
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 10:00AM - 5:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
SHIJY JOYKUTTY APRN 86902
LIJI SEILAS APRN 81805
BEENA THOMAS APRN 94626

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