PETERSON, WENDY KAY - Licensee Information

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Last Update: Monday, December 23, 2024 3:49 AM CST
Next Update: Monday, December 23, 2024 12:00 PM CST

PETERSON, WENDY KAY

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:	FUSION MD 5472 MAIN STREET STE 101 DEL CITY OK 73115 Address last updated on 7/16/2024
Phone #:	(405) 622-3699
Fax #:
County:	OKLAHOMA
License:	2991
Dated:	11/8/2018
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:
FUSION MD 5472 MAIN STREET STE 101 DEL CITY OK 73115 Phone #: (405) 622-3699 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
AUDRALAN GAYLE FOX	MD	25086
JAMES LE	DO	5402
ELIZABETH ALICE WICKERSHAM	MD	20273

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