MIETUS, NICHOLAS ALBERT - Licensee Information

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

MIETUS, NICHOLAS ALBERT

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:	NORTHERN OKLAHOMA DERMATOLOGY LLC 309 SE FRANK PHILLIPS BLVD BARTLESVILLE OK 74003 Address last updated on 3/27/2024
Phone #:	(918) 241-8888
Fax #:
County:	WASHINGTON
License:	2854
Dated:	1/3/2018
Expires:	3/31/2025
Temp. Ltr. Issued:	1/18/2018
Temp. Ltr. Expires:	3/8/2018
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:
NORTHERN OKLAHOMA DERMATOLOGY LLC 309 SE FRANK PHILLIPS BLVD BARTLESVILLE OK 74003 Phone #: (918) 241-8888 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
RAYMOND LOUIS CORNELISON JR	MD	9074
TAMARA LYNN HILL	MD	17349

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