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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, December 22, 2024 6:44 PM CST
Next Update: Monday, December 23, 2024 2:50 AM CST

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HICKMAN, JEFFERY CHARLES       
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: VARIETY CARE
201 1ST STREET
GRANDFIELD OK 73546

Address last updated on 3/29/2024
Phone #: (405) 632-6688
Fax #:
County: TILLMAN
License: 1298
Dated: 11/20/2003
Expires: 3/31/2025
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
1/28/2021 Probation Ended
1/28/2016 License Reinstated
6/13/2014 Surrendered License
4/1/2014 Complaint Citation
5/5/2005 Probation
Board Filings and/or Orders:
02/02/2016
07/29/2015
06/13/2014
05/23/2014
03/28/2014
03/28/2014
05/05/2005
03/24/2005
03/24/2005
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
VARIETY CARE
201 1ST STREET
GRANDFIELD OK 73546

Phone #: (405) 632-6688
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
GLENN DAVIS MD 38899
ASHISH DUSHANT GUPTA MDC 41517
HENRY DEAN VAUGHAN DO 2031

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