COSTULAS, ALENA NICOLE - 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

COSTULAS, ALENA NICOLE

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 PRIMARY CARE 520 SOUTH MUSTANG RD YUKON OK 73099 Address last updated on 9/23/2024
Phone #:	(405) 936-5910
Fax #:
County:	CANADIAN
License:	4902
Dated:	11/1/2022
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 PRIMARY CARE 520 SOUTH MUSTANG RD YUKON OK 73099 Phone #: (405) 936-5910 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:	Full/Part Time:
Primary Supervisor(s):
NESTOR FERNANDEZ PINAROC	MD	19456

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