BRUNDIDGE, KASEY LEE - Licensee Information

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

BRUNDIDGE, KASEY 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:	ADA HEALTH FIRST - FAMILY PRACTICE 1414 ARLINGTON ST, STE 1400 ADA OK 74820 Address last updated on 12/11/2024
Phone #:	(580) 279-1788
Fax #:	(580) 279-1790
County:	PONTOTOC
License:	1618
Dated:	2/13/2007
Expires:	3/31/2025
Temp. Ltr. Issued:	2/1/2007
Temp. Ltr. Expires:	5/19/2007
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:
ADA HEALTH FIRST - FAMILY PRACTICE 1414 ARLINGTON ST, STE 1400 ADA OK 74820 Phone #: (580) 279-1788 Fax #: (580) 279-1790

Hospital Privileges:

Mercy Hospital Ada (frmly Valley View Regional Hospital)
Ada, OK

Name:	Type:	License Number:
Primary Supervisor(s):
GLEN EDWARD DIACON JR	MD	16231
MICHAEL ZANN MCMAHAN	MD	24591
MICHAEL STAFFORD	DO	2397

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