PRIM, REBECCA GRACE - 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

PRIM, REBECCA GRACE

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:	CLINIC - TINKER AFB 7050 AIR DEPOT BLDG 1094 TINKER AFB OK 73145 Address last updated on 3/6/2024
Phone #:	(405) 734-2778
Fax #:	(405) 736-3619
County:	OKLAHOMA
License:	1690
Dated:	1/17/2008
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: No Disciplinary Action Taken.

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Locations:	Hours:	Languages:
CLINIC - TINKER AFB 7050 AIR DEPOT BLDG 1094 TINKER AFB OK 73145 Phone #: (405) 734-2778 Fax #: (405) 736-3619

Hospital Privileges:

None listed

Name:	Type:	License Number:	Full/Part Time:
Primary Supervisor(s):
SHANE OLIVER BIEDERMANN	MD	30934

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