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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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FANNING, KYLE WYATT
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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.
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| Practice Address: |
1401 SW 34TH STREET SUITE 200
MOORE OK 73160
Address last updated on 4/6/2020 |
| Phone #: |
(405) 793-9221 |
| Fax #: |
(405) 793-0288 |
| County: |
CLEVELAND |
| License: |
17631 |
| Dated: |
5/18/1991 |
| Expires: |
5/1/2024 |
| License Type: |
Medical Doctor |
| Specialty: |
Family Medicine |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Univ Of KS Sch Of Med, Kansas City Ks 66103 |
| Graduated: |
5 /
1982 |
| CME Year: |
2025 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
ABPS - Family Medicine |
| New Patients: |
Yes |
| Medicaid: |
No |
| Medicare: |
No |
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| HMO/PPO: |
Aetna HMO
Aetna Managed Choice
Beechstreet PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
BlueChoice PPO
BlueLincs HMO
CIGNA HMO
CIGNA PPO
CommunityCare HMO, Inc
Coventry Health Care National Network
First Health
Pacificare Commercial HMO
PacifiCare of Oklahoma, Inc
PHCS (Private Healthcare Systems)
Private Healthcare Systems (PHCS)
United Healthcare Choice
United Healthcare EPO
United Healthcare HMO
United Healthcare Options PPO
United Healthcare POS
USA Managed Care |
| Hospital Privileges: |
INTEGRIS Baptist Medical Center
Oklahoma City, OK
INTEGRIS Southwest Medical Center
Oklahoma City, OK
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| Locations: |
Hours: |
Languages: |
1401 SW 34TH STREET SUITE 200
MOORE OK 73160
Phone #:
(405) 793-9221
Fax #:
(405) 793-0288 |
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 7:30AM - 12:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun: |
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