CALDWELL, KAMMIE MARIA - Licensee Information

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

CALDWELL, KAMMIE MARIA

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:	CALDWELL MEDICAL GROUP 2109 S HIGHWAY 69 WAGONER OK 74467-4629 Address last updated on 7/3/2024
Phone #:	(918) 485-6069
Fax #:
County:	WAGONER
License:	24211
Dated:	9/23/2004
Expires:	9/1/2025
License Type:	Medical Doctor
Specialty:	Internal Medicine

Status:	Active
Status Class:	Fully Licensed
Restricted to:
Registered to Dispense:	YES
Medical School:	Dartmouth Med, Hanover Nh 03755
Graduated:	6 / 2001
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:
New Patients:	Yes
Medicaid:	Yes
Medicare:	Yes

HMO/PPO:	Aetna HMO Aetna PPO Blue Cross Blue Shield-Blue Preferred Blue Cross Blue Shield-Blue Traditional Blue Cross Blue Shield-Plan 65 Select BlueChoice PPO BlueLincs HMO CIGNA HMO CIGNA PPO CommunityCare HMO, Inc CommunityCare Senior HMO Coventry Health Care National Network Dept of Rehabilitation Services (DRS) First Health Global Health HMO HealthChoice Heartland Health Plan of Oklahoma Humana ChoiceCare Humana Medicare Advantage PPO Humana Tricare/PGBA Oklahoma Health Network PPO OSMA Health (formerly Plico PPO) PacifiCare of Oklahoma, Inc Physicians Direct Network Preferred Community Choice Secure Horizons HMO SoonerCare HMO Tricare Standard United Healthcare HMO
Hospital Privileges:	Wagoner Community Hospital Wagoner, OK

Locations:	Hours:	Languages:
CALDWELL MEDICAL GROUP 2109 S HIGHWAY 69 WAGONER OK 74467-4629 Phone #: (918) 485-6069 Fax #:	Mon: Tue: Wed: Thu: Fri: Sat: Sun:
2601 N Aspen Suite 1011 Broken Arrow, OK 74012 Phone #: (918) 485-2104 Fax #: (8) 201-	Mon: Tue: Wed: Thu: 1:00PM - 5:00PM Fri: 8:00AM - 5:00PM Sat: Sun:
2309 s. I-35 Service Road moore, OK 73160 Phone #: (405) 543-7200 Fax #: (1) 201-	Mon: Tue: Wed: Thu: Fri: Sat: Sun:
2104 S. Main Street Grove, OK 74344 Phone #: (417) 459-2211 Fax #: (1) 201-	Mon: 9:00AM - 5:00AM Tue: 9:00AM - 5:00PM Wed: 9:00AM - 5:00PM Thu: 9:00AM - 5:00PM Fri: 9:00AM - 5:00PM Sat: Sun:

Name:	Type:	License Number:
Primary Supervisees(s):
RICHARD BARNES	APRN	62092
KIMBERLY BUFFALO	APRN	12781
MICHELLE LACY	APRN	107030
BARBARA MARSHALL	APRN	95120
JALYSSA ERICKA VALENCIA	PA	4938
KENNETH WARREN	APRN	50761

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