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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, November 25, 2024 3:47 AM CST
Next Update: Monday, November 25, 2024 12:00 PM CST

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JACKSON, JESSICA ELISE       
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: 2212 N BROADWAY AVE
MOORE OK 73160

Address last updated on 4/30/2024
Phone #: (405) 285-7222
Fax #:
County: CLEVELAND
License: 2725
Dated: 1/26/2017
Expires: 3/31/2025
Temp. Ltr. Issued: 12/29/2016
Temp. Ltr. Expires: 3/2/2017
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:
2212 N BROADWAY AVE
MOORE OK 73160

Phone #: (405) 285-7222
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
DUSTIN RILEY BAKER MD 23973
JOSEPH CLIFTON BROOME MD 23006
JAMES LE DO 5402
CYRUS DEAN MOTAZEDI DO 3977
RICKY GRAY SWAIM MD 26151

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