GARDNER, LACEY JO - Licensee Information

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

GARDNER, LACEY JO

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:	ROWLAND FLATT CLINIC 603 NE 2ND STREET ANTLERS OK 74523 Address last updated on 3/28/2024
Phone #:	(580) 298-3351
Fax #:
County:	PUSHMATAHA
License:	4503
Dated:	4/2/2021
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:
ROWLAND FLATT CLINIC 603 NE 2ND STREET ANTLERS OK 74523 Phone #: (580) 298-3351 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
DAVID CAMPBELL	DO	4465
VICTORIA E. PARDUE	DO	2840
TEDDY RAY ROWLAND	MD	14790

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