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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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POK, VISAL       
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: MERCY CLINIC EDMOND I-35 SOUTH
2301 W. I-35 FRONTAGE ROAD SUITE 210
EDMOND OK 73013

Address last updated on 5/2/2024
Phone #: (405) 757-3365
Fax #: (405) 757-3506
County: OKLAHOMA
License: 24047
Dated: 6/1/2006
Expires: 6/1/2025
License Type: Medical Doctor
Specialty: Family 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: 5 / 2004
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
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
MERCY CLINIC EDMOND I-35 SOUTH
2301 W. I-35 FRONTAGE ROAD SUITE 210
EDMOND OK 73013

Phone #: (405) 757-3365
Fax #: (405) 757-3506
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
MEREDITH STORM BOLT PA 2714
STACY LOUISE FAGAN PA 1779
CHRISTINA MICHELLE HELMS PA 1986
JEFFREY NEIL JOHNSTON PA 2508
CARRIE HOPE MCGUIRE PA 1510
MEGAN ELIESE MITCHELL PA 2230
LAURI STUCKI APRN 67460
CHRISTOPHER AQUIES TAYLOR PA 2259
VERONICA ZOLLO APRN 54855

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