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Oklahoma Board of Medical Licensure and Supervision

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

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MATHES, NICOLE PAOLA       
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: AMG ST JOHN PRIMARY CARE BROKEN ARROW
800 W BOISE CIR STE 160
BROKEN ARROW OK 74012-4932

Address last updated on 7/9/2024
Phone #:
Fax #:
County: TULSA
License: 43726
Dated: 7/8/2024
Expires: 7/1/2025
License Type: Medical Doctor
Specialty: Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of TX Southwestern Med Sch At Dallas SW Med Sch, Dallas Tx 75235
Graduated: 6 / 2011
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: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
AMG ST JOHN PRIMARY CARE BROKEN ARROW
800 W BOISE CIR STE 160
BROKEN ARROW OK 74012-4932

Phone #:
Fax #:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
ANTHONY NICHOLAS BARBETTINI PA 1347
MEGAN BLAIRE KASSEM PA 2881

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