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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 6:42 PM CST
Next Update: Saturday, November 23, 2024 2:50 AM CST

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WICKERSHAM, ELIZABETH ALICE       
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: 1000 N LEE
OKLAHOMA CITY OK 73102

Address last updated on 6/25/2024
Phone #: (405) 272-6406
Fax #: (405) 772-4430
County: OKLAHOMA
License: 20273
Dated: 7/10/1997
Expires: 7/1/2025
Training Issued: 7/1/1996
Training Expires: 8/1/1997
License Type: Medical Doctor
Specialty: Family Medicine
Palliative Medicine
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: 6 / 1996
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 FAMILY MEDICINE
AMERICAN BOARD OF FAMILY MEDICINE - Hospice and Palliative Medicine
New Patients: No
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
Blue Cross Blue Shield-Plan 65 Select
BlueChoice PPO
BlueLincs HMO
CommunityCare HMO, Inc
First Health
Great West Healthcare
HealthChoice
OSMA Health (formerly Plico PPO)
Pacificare Commercial HMO
PacifiCare of Oklahoma, Inc
PHCS (Private Healthcare Systems)
Physicians Direct Network
PPO USA
Preferred Community Choice
Private Healthcare Systems (PHCS)
Railroad Medicare
Secure Horizons HMO
Tricare for Life
Tricare Standard
United Healthcare Choice
United Healthcare EPO
United Healthcare HMO
United Healthcare Options PPO
United Healthcare POS
Hospital Privileges: INTEGRIS Baptist Medical Center
Oklahoma City, OK
Jackson County Memorial Hospital
Altus, OK
SSM Health St. Anthony Hospital - OKC
Oklahoma City, OK
SSM Health St. Anthony Shawnee Hospital (fmly Unity Health Ctr)
Shawnee, OK
Locations: Hours: Languages:
1000 N LEE
OKLAHOMA CITY OK 73102

Phone #: (405) 272-6406
Fax #: (405) 772-4430
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
TIMOTHY RYAN BRAUN PA 2712
DARLLA DENISE DUNIPHIN PA 1257
WENDY KAY PETERSON PA 2991
BRUNA MAE VARALLI-CLAYPOOL PA 1028

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