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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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DUNCAN, AMBER       
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: INTEGRIS HEALTH GRAND LAKE SURGERY
2229 S MAIN ST
GROVE OK 74344

Address last updated on 2/23/2024
Phone #: (918) 786-7300
Fax #:
County: DELAWARE
License: 4974
Dated: 2/24/2023
Expires: 3/31/2025
Temp. Ltr. Issued: 1/18/2023
Temp. Ltr. Expires: 3/16/2023
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:
INTEGRIS HEALTH GRAND LAKE SURGERY
2229 S MAIN ST
GROVE OK 74344

Phone #: (918) 786-7300
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
Haley Suzane Adams DO 5705
JAMES DULL RUTTER IV MD 21574
KYLE CLARK WOODERSON DO 4824

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