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Oklahoma Board of Medical Licensure and Supervision

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HILL, JESSE RAY       
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
4300 W MEMORIAL
OKLAHOMA CITY OK 73120

Address last updated on 12/27/2023
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County: OKLAHOMA
License: 26139
Dated: 2/12/2008
Expires: 2/1/2025
Temp. Lic. Issued: 1/31/2008
Temp. Lic. Expires: 3/15/2008
License Type: Medical Doctor
Specialty: Emergency 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: 5 / 2005
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: AMERICAN BOARD OF EMERGENCY MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Mercy Hospital OKC
Oklahoma City, OK
Locations: Hours: Languages:
MERCY
4300 W MEMORIAL
OKLAHOMA CITY OK 73120

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5721 NW 132nd St.
Oklahoma City, OK 73142

Phone #: (405) 441-6793
Fax #: (11) 202-
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1429 Nw 150th St
Edmond, OK 73013

Phone #: (405) 441-6793
Fax #: (11) 202-
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15301 A STE B Crown at Lone Oak
Edmond, OK 73013

Phone #: (405) 441-6793
Fax #: (12) 202-
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Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
JACOB C. BROWN PA 2738
THOMAS FRASIER ENGLE PA 1786
NATHAN WAYNE FITE PA 2309
BRITTANY NICOLE FLEMINGS PA 2333
JAMI GRANTZ APRN 69333
KAYLA HALE PA 2806
DANIEL LESTER HARRIS JR PA 2301
SCOTT RANDALL INTERWICZ PA 2304
JEFFREY NEIL JOHNSTON PA 2508
CYNTHIA LANEALE ROBERTSON PA 2440
ROY KENT ROGERS PA 812
TYLER SMITH APRN 105650
JOSEPH N STANCAMPIANO PA 4679
CARLOS VENEGAS JR APRN 116073
KENNETH BRUCE WALKER PA 1270
RACHEL WITMER PA 2655

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