LIPKE, KYLE NATHAN - 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

LIPKE, KYLE NATHAN

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:	MERCY PRIMARY CARE EDMOND WATERLOO 301 EAST WATERLOO EDMOND OK 73034 Address last updated on 8/24/2024
Phone #:	(405) 715-2000
Fax #:	(405) 715-2010
County:	LOGAN
License:	1667
Dated:	10/18/2007
Expires:	3/31/2025
Temp. Ltr. Issued:	9/20/2007
Temp. Ltr. Expires:	11/3/2007
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:
MERCY PRIMARY CARE EDMOND WATERLOO 301 EAST WATERLOO EDMOND OK 73034 Phone #: (405) 715-2000 Fax #: (405) 715-2010

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
MICHAEL STEPHEN ELLIOTT	MD	19806
Jacob Lynn Fisher	DO	6163
ABDALLAH MOHAMMED HUSSEIN	MD	29421

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