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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, December 23, 2024 3:49 AM CST
Next Update: Monday, December 23, 2024 12:00 PM CST

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HARGROVE, KEVIN WAYNE       
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: 101 SOUTH SAINTS BLVD
SUITE 101
EDMOND OK 73034

Address last updated on 6/2/2024
Phone #: (405) 513-8326
Fax #: (405) 513-7739
County: OKLAHOMA
License: 16493
Dated: 7/1/1988
Expires: 7/1/2025
Training Issued: 8/24/1987
Training Expires: 9/30/1988
License Type: Medical Doctor
Specialty: Orthopedic Surgery
Sports Medicine (Orthopedic Surgery)
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 1987
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: AMERICAN BOARD OF ORTHOPAEDIC SURGERY
New Patients: Yes
Medicaid: No
Medicare: Yes
   
HMO/PPO: Aetna Elect Choice
Aetna Managed Choice
Aetna PPO
CIGNA PPO
Evolutions Healthcare
First Health
HealthChoice
One Health Plan PPO
OSMA Health (formerly Plico PPO)
Private Healthcare Systems (PHCS)
United Healthcare POS
Hospital Privileges: Community Hospital - OKC
Oklahoma City, OK
Hospital Not Listed
,
McBride Orthopedic Hospital
Oklahoma City, OK
Mercy Hospital OKC
Oklahoma City, OK
OneCore Health OKC
Oklahoma City, OK
Surgery Center of Oklahoma
Oklahoma City, OK
Locations: Hours: Languages:
101 SOUTH SAINTS BLVD
SUITE 101
EDMOND OK 73034

Phone #: (405) 513-8326
Fax #: (405) 513-7739
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
JUSTIN MILES BROUS AT 1236
SAMANTHA DAWN CARTER AT 930
DONALD RAY FLINN PA 317
RALPH EUGENE FOUNTAIN PA 498
JASON LEE KELTNER AT 174
CURTIS WRIGHT MCAULIFF AT 189
WILLIAM ROSS MCCULLOH AT 616
CHAD MICHAEL MILLER AT 203
BRETT DILLON PURVIS PA 1773

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