STOVALL, CAMRYN TRICE - 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

STOVALL, CAMRYN TRICE

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 EDMOND I-35 2017 W I-35 FRONTAGE ROAD SUITE 170 EDMOND OK 73013 Address last updated on 2/26/2024
Phone #:	(405) 757-3742
Fax #:
County:	OKLAHOMA
License:	4597
Dated:	6/17/2021
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:
MERCY CLINIC PRIMARY CARE EDMOND I-35 2017 W I-35 FRONTAGE ROAD SUITE 170 EDMOND OK 73013 Phone #: (405) 757-3742 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
Matthew Bryan Austin	DO	5348
ERIKA ELISE BREEDLOVE	MD	30748
RYAN NEAL GOTCHER	MD	29975

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