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Oklahoma Board of Medical Licensure and Supervision

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

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DAVIS, KELLY VAN       
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: 2488 E 81ST ST TOWER 2
STE 482
TULSA OK 74137

Address last updated on 5/3/2024
Phone #: (539) 525-0314
Fax #: (539) 867-2657
County: TULSA
License: 23418
Dated: 6/20/2005
Expires: 6/1/2025
License Type: Medical Doctor
Specialty: Internal Medicine
Hospitalist
Endocrinology, Diabetes and Metabolism
Rheumatology
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 / 2003
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: ABPS - Internal Medicine
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: Hillcrest Medical Center
Tulsa, OK
Moore Medical Center
Moore, OK
Norman Regional Hospital
Norman, OK
Physicians Hospital of Oklahoma
Oklahoma City, OK
V.A. Medical Center-OKC
Oklahoma City, OK
Valley Community Hospital (fmly Pauls Valley General)
Pauls Valley, OK
Wagoner Community Hospital
Wagoner, OK
Locations: Hours: Languages:
2488 E 81ST ST TOWER 2
STE 482
TULSA OK 74137

Phone #: (539) 525-0314
Fax #: (539) 867-2657
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
GINA GRADY APRN 70010
JACINDA HANTAK APRN 96351
BROOK LELAND APRN 4621
MEGAN ELIESE MITCHELL PA 2230
DAVID RACKLEY APRN 4954
AMANDA ROBERTSON APRN 17309
EMILY SHOCKLEY APRN 10464

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