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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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HEATON, KALIN T       
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: SSM HEALTH ST ANTHONY HOSPITAL
1111 N DEWEY AVE
OKLAHOMA CITY OK 73103

Address last updated on 2/13/2024
Phone #: (405) 272-9671
Fax #:
County: OKLAHOMA
License: 4673
Dated: 11/2/2021
Expires: 3/31/2025
Temp. Ltr. Issued: 10/26/2021
Temp. Ltr. Expires: 11/18/2021
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:
SSM HEALTH ST ANTHONY HOSPITAL
1111 N DEWEY AVE
OKLAHOMA CITY OK 73103

Phone #: (405) 272-9671
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
SCOTT MARTIN DE LA GARZA MD 21981
JESSICA ANN FAUGHT MD 37344
TIMOTHY MICHAEL GEIB MD 22888
JOHN LARSON GLOMSET III MD 29497
JACOB ASHER HAYNES MD 33602
SEETHAL RAO MADHAVARAPU MD 23053
CLAYTON ELLIS NELSON MD 29279
COREY EUGENE PONDER MD 22884
DOUGLAS JAY ROWLES MD 30905

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