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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, December 22, 2024 6:44 PM CST
Next Update: Monday, December 23, 2024 2:50 AM CST

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TKACH, THOMAS KELLY       
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: MCBRIDE ORTHOPEDIC HOSPITAL
9600 BROADWAY EXTENSION
OKLAHOMA CITY OK 73114-7408

Address last updated on 6/3/2024
Phone #: (405) 230-9425
Fax #: (405) 230-9477
County: OKLAHOMA
License: 17380
Dated: 7/12/1990
Expires: 7/1/2025
Training Issued: 6/1/1989
Training Expires: 9/30/1990
License Type: Medical Doctor
Specialty: Orthopedic Surgery
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 1989
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: Contact licensee
Medicare: Yes
   
HMO/PPO: Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
Blue Cross Blue Shield-Plan 65 Select
BlueChoice PPO
HealthChoice
United Healthcare Options PPO
Hospital Privileges: McBride Orthopedic Hospital
Oklahoma City, OK
SSM Health Bone and Joint Hospital at St. Anthony
Oklahoma City, OK
Locations: Hours: Languages:
MCBRIDE ORTHOPEDIC HOSPITAL
9600 BROADWAY EXTENSION
OKLAHOMA CITY OK 73114-7408

Phone #: (405) 230-9425
Fax #: (405) 230-9477
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: 8:00AM - 5:00PM
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
RYAN BALLARD PA 2095
MATTHEW STEVEN BERTUS PA 861
NATHAN JAMES CHARLTON PA 2499
DONALD RAY FLINN PA 317
RALPH EUGENE FOUNTAIN PA 498
DAVID SHANNON HADDOCK PA 2055
LUKE DANIEL HANEY PA 1697
JOANNA LEE HART PA 1236
AMBER DAWN HAYNES PA 1945
HEATHER HEDRICK APRN 71708
STEPHEN MICHAEL ISERNHAGEN PA 2613
JOHN GILBERT MILLER PA 1187
KAYTI MOXLEY APRN 58951
CHRISTOPHER SCOT PACE PA 1843
ALLYSON ANN PINKLEY PA 2184
BRETT DILLON PURVIS PA 1773
MICHAEL LYNN SANDERSON PA 1808
AUSTIN JAMES SHOMAN PA 4626
ANDREW BLAKE SMITH PA 2584
AARON CLAY WADE PA 866
AMY CHRISTINE WALKER PA 1419
JEFFREY SCOTT WALTER PA 1029

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