BULLOCK, HEATHER PATRICIA - 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

BULLOCK, HEATHER PATRICIA

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 PAIN MANAGEMENT I35 2017 WEST I-35 FRONTAGE ROAD SUITE 130 EDMOND OK 73013 Address last updated on 3/11/2024
Phone #:	(405) 757-3630
Fax #:
County:	OKLAHOMA
License:	4976
Dated:	2/24/2023
Expires:	3/31/2025
Temp. Ltr. Issued:	11/18/2022
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:
MERCY PAIN MANAGEMENT I35 2017 WEST I-35 FRONTAGE ROAD SUITE 130 EDMOND OK 73013 Phone #: (405) 757-3630 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
SHAWN ELLIS	DO	4757
RYAN ALAN VINCENT	MD	30777

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