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Oklahoma Board of Medical Licensure and Supervision

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

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COBURN, NICOLE ST. AMANT       
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: ST. JOHN MEDICAL CENTER
1923 S UTICA
TULSA OK 74104

Address last updated on 3/3/2024
Phone #: (918) 744-2345
Fax #:
County: TULSA
License: 3176
Dated: 2/14/2020
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:
ST. JOHN MEDICAL CENTER
1923 S UTICA
TULSA OK 74104

Phone #: (918) 744-2345
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
JOHN GLADSTONE ABRAHAM MD 27255
PALLAVI AGARWAL MD 23998
SERGII VJACHESLAVOVITCH ALEKSEIEV MD 28599
DEBORAH JAN BEESON MD 13091
ZEYFOULA BEYTOULA MD 27073
Ashesh Bhakta DO 6283
JOSHUA TOBIN CALVERT MD 25602
STEPHEN TIMOTHY CALVERT MD 22446
BRENNON COX DO 3940
DAVID PAUL D'ALESSANDRO MD 25100
KOMI SEMENOU FOLLY JR MD 25817
JOHN GEMMA DO 5744
DAVID NELSON GILBERT MD 24621
PRITI GURUNG MD 27849
DAWN JOY HENSLEY DO 4522
TIMOTHY GEORGE IHRIG MD 35554
SHAHNAWAZ CHAUDHRY IJAZ MD 33937
JULIA MARGARET KWON DO 4783
JILL MANAHAN LAGASO MD 27689
MICHAEL CHASE LEDBETTER DO 5585
BLAKE JUSTIN LESSELROTH MD 34337
Amanda Lucashu DO 6095
PETER MICHAEL MADDEN MD 31595
TAMER MADRIGAL MD 30049
DEREK M MATHESON DO 4359
HAYDEN MARIE NOVAK MD 34685
MICHELLE MARIE OLMSTEAD-MILLS DO 5259
ESTHER MARIE PAPP MD 32429
NICHOLAS PELUSO DO 5927
JAMES REED PHILLIPS MD 19743
JEANNETTE CAROLINA POWER MD 25814
Grisel Yuliana Quiroz DO 6040
MELODY MEANS RACHAL MD 24090
SARA ARIANA RAFAEL DO 5033
GERALD REED DO 3284
MONICA SAENZ DO 5160
Caleb McKenzie Severns DO 6253
MEHVISH SHAH DO 5437
SCOTT T SHEPHERD DO 4809

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