KELLY, STEPHEN BLAKE - Licensee Information

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

KELLY, STEPHEN BLAKE

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:	OKLAHOMA PAIN CENTER 13921 NORTH MERIDIAN AVE SUITE 100 OKLAHOMA CITY OK 73134 Address last updated on 6/2/2024
Phone #:	(405) 752-9600
Fax #:	(405) 752-9650
County:	OKLAHOMA
License:	21242
Dated:	7/7/1999
Expires:	7/1/2025
Training Issued:	7/2/1998
Training Expires:	8/1/1999
License Type:	Medical Doctor
Specialty:	Family Medicine Pain Medicine

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 / 1998
CME Year:	2026

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:
New Patients:	Yes
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 CCN Managed Care Champ VA CIGNA HMO CIGNA PPO CommunityCare HMO, Inc CommunityCare Senior HMO Coventry Health Care National Network First Health Focus Healthcare Galaxy Health Network Global Health HMO Great West Healthcare Health Smart Preferred Care (HSPC) HealthChoice Heartland Health Plan of Oklahoma Humana ChoiceCare Humana Medicare Advantage PPO Humana Tricare/PGBA Medicare Blue Multiplan PPO National Preferred Provider Network (NPPN) One Health Plan PPO OSMA Health (formerly Plico PPO) Pacificare Commercial HMO PacifiCare of Oklahoma, Inc PHCS (Private Healthcare Systems) Physicians Direct Network PPO USA Preferred Community Choice Preferred Health Network-ppoNEXT Prime Advantage Health Plan Private Healthcare Systems (PHCS) Prudential Health Care Plan, Inc Railroad Medicare Secure Horizons HMO Tricare for Life Tricare Standard UniCare Health Plans of Oklahoma United Healthcare Choice United Healthcare EPO United Healthcare HMO United Healthcare Options PPO United Healthcare POS
Hospital Privileges:	None listed

Locations:	Hours:	Languages:
OKLAHOMA PAIN CENTER 13921 NORTH MERIDIAN AVE SUITE 100 OKLAHOMA CITY OK 73134 Phone #: (405) 752-9600 Fax #: (405) 752-9650	Mon: Tue: Wed: Thu: Fri: Sat: Sun:

Name:	Type:	License Number:
Primary Supervisees(s):
BUFFY DAMRON	PA	1332
HASSAN M KARIM	PA	2353
JENNIFER ANN MCREYNOLDS	PA	1415
MATTHEW MUNDA	APRN	106050
COURTNEY LAUREN PRICE	PA	2954
MEREDITH ADELE PRUITT	PA	1869
KARIE STEWART	APRN	90059

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