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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, December 21, 2024 3:49 AM CST
Next Update: Saturday, December 21, 2024 12:00 PM CST

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VASSAR, CODIE JORDAN       
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: 14453 SE 29TH STREET STE D
CHOCTAW OK 73020-2014

Address last updated on 3/26/2024
Phone #:
Fax #:
County: OKLAHOMA
License: 39043
Dated: 2/22/2022
Expires: 2/1/2025
License Type: Medical Doctor
Specialty: Psychiatry
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Med Coll Of Wi, Milwaukee Wi 53226
Graduated: 5 / 2017
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: ABPS - Psychiatry
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
14453 SE 29TH STREET STE D
CHOCTAW OK 73020-2014

Phone #:
Fax #:
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Tue:
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Sat:
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Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
CHASITY JANE BUTLER PA 2661
NICOLINE EDIE APRN 118299
PRUDENCIA IJEOMA TANKEU APRN 10566
NGOMENI MBILIKIRA APRN 14030
IFEOMA OGBALU APRN 9925
ELIZABETH UMEMBA APRN 135049
CHELSEA L WALDROP PA 5074

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