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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 6:42 PM CST
Next Update: Saturday, November 23, 2024 2:50 AM CST

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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

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

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