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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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MILLER, CANDIECE NICOLE       
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: SSM
608 NW 9TH ST #5100
OKLAHOMA CITY OK 73102

Address last updated on 10/29/2024
Phone #: (405) 772-8687
Fax #:
County: OKLAHOMA
License: 1167
Dated: 4/1/2002
Expires: 3/31/2025
Temp. Ltr. Issued: 12/13/2001
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:
SSM
608 NW 9TH ST #5100
OKLAHOMA CITY OK 73102

Phone #: (405) 772-8687
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
ADAM D. GARDNER MD 30575
SYED JEHANZEB ALI NAQVI MD 28003
Peter Studebaker DO 6827

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