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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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PORTER, KIMBERLY KAY       
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: 921 NE 13TH STREET
OKLAHOMA CITY OK 73104

Address last updated on 2/22/2022
Phone #: (405) 456-1000 x4657
Fax #:
County: OKLAHOMA
License: 20583
Dated: 3/26/1998
Expires: 3/1/2025
Training Issued: 6/30/1994
Training Expires: 6/1/1998
License Type: Medical Doctor
Specialty: Internal Medicine
GERIATRICS
Hospitalist
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Southern Il Univ Sch Of Med, Springfield Il 62794
Graduated: 6 / 1994
CME Year: 2025
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 INTERNAL MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: V.A. Medical Center-OKC
Oklahoma City, OK
Locations: Hours: Languages:
921 NE 13TH STREET
OKLAHOMA CITY OK 73104

Phone #: (405) 456-1000 x4657
Fax #:
Mon: I WORK 7DAYS ON AND 7 DAYS OFF
Tue:
Wed:
Thu:
Fri:
Sat:
Sun: I WORK AS A HOSPITALIST
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
COMFORT ADEYEMI APRN 103125
AMANDA DEAN RUSSELL PA 4629

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