GREEN, TERESA DESHAWN - 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

GREEN, TERESA DESHAWN

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:	PINE RIDGE MENTAL HEALTHCARE 8422 N 123RD EAST AVENUE OWASSO OK 74055 Address last updated on 3/15/2024
Phone #:	(918) 858-4353
Fax #:	(866) 246-2942
County:	TULSA
License:	2962
Dated:	9/6/2018
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:
PINE RIDGE MENTAL HEALTHCARE 8422 N 123RD EAST AVENUE OWASSO OK 74055 Phone #: (918) 858-4353 Fax #: (866) 246-2942

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
Nick Lee Carroll	DO	4745
DWIGHT JULIUS KORGAN	MD	11178
NAVEEN NANDIGAMA KUMAR	MD	20037

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