ELLIS, STACY LUANN - 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

ELLIS, STACY LUANN

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:	STILLWATER MEDICAL URGENT CARE 518 E LAKEVIEW RD STILLWATER OK 74075 Address last updated on 9/10/2024
Phone #:	(405) 533-8990
Fax #:
County:	PAYNE
License:	1724
Dated:	1/29/2008
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:
STILLWATER MEDICAL URGENT CARE 518 E LAKEVIEW RD STILLWATER OK 74075 Phone #: (405) 533-8990 Fax #:

Hospital Privileges:

Hospital(s) Not In Oklahoma
,

Name:	Type:	License Number:	Full/Part Time:
Primary Supervisor(s):
MICHAEL DAVID LANDES	MD	31092

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