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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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SMITH, ALYSIA MOTA       
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: MERCY CLINIC PRIMARY CARE MOORE
1060 SW 4TH STREET
MOORE OK 73160

Address last updated on 7/9/2024
Phone #: (405) 378-5491
Fax #: (405) 378-5492
County: CLEVELAND
License: 4487
Dated: 11/2/2020
Expires: 3/31/2025
Temp. Ltr. Issued: 10/20/2020
Temp. Ltr. Expires: 11/5/2020
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:
MERCY CLINIC PRIMARY CARE MOORE
1060 SW 4TH STREET
MOORE OK 73160

Phone #: (405) 378-5491
Fax #: (405) 378-5492

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
Tabitha D. Danley DO 4025
MISTY DAWN HSIEH MD 22009
ROBERT WILLIAM RADER MD 21263

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