RIDENOUR, JARED VAUGHN - 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

RIDENOUR, JARED VAUGHN

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:	UTICA PARK CLINIC 8803 S 101ST E AVE #100 TULSA OK 74133 Address last updated on 9/9/2024
Phone #:	(918) 574-0220
Fax #:
County:	TULSA
License:	3021
Dated:	2/14/2019
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:
UTICA PARK CLINIC 8803 S 101ST E AVE #100 TULSA OK 74133 Phone #: (918) 574-0220 Fax #:

Hospital Privileges:

Hillcrest Hospital South (fmly SouthCrest)
Tulsa, OK
Hillcrest Medical Center
Tulsa, OK
Tulsa Spine & Specialty Hospital
Tulsa, OK

Name:	Type:	License Number:
Primary Supervisor(s):
RICHARD DRAKE	DO	4066
DANIEL MARTIN HARWELL	MD	32880
MICHAEL THAMBUSWAMY	MD	31253

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