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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, November 23, 2024 3:48 AM CST
Next Update: Saturday, November 23, 2024 12:00 PM CST

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CARMOUCHE', SHANNAN LEE       
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: 9800 BROADWAY EXTENSION SUITE 200
OKLAHOMA CITY OK 73114-6304

Address last updated on 2/4/2024
Phone #: (405) 715-4496
Fax #: (405) 715-4499
County: CLEVELAND
License: 1162
Dated: 4/1/2002
Expires: 3/31/2025
Temp. Ltr. Issued: 12/6/2001
Temp. Ltr. Expires: 3/31/2002
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
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.
Locations: Hours: Languages:
9800 BROADWAY EXTENSION SUITE 200
OKLAHOMA CITY OK 73114-6304

Phone #: (405) 715-4496
Fax #: (405) 715-4499

Hospital Privileges:

Community Hospital - OKC
Oklahoma City, OK
Northwest Surgical Hospital
Oklahoma City, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
BENJAMIN JOSEPH BARENBERG MD 29683
NOEL ROBERT WILLIAMS MD 17885

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