HICKMAN, RACHAEL ANN - 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

HICKMAN, RACHAEL ANN

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:	REVIVE CLINIC 13316 S WESTERN AVE OKLAHOMA CITY OK 73170 Address last updated on 2/29/2024
Phone #:	(405) 703-8882
Fax #:
County:	CLEVELAND
License:	5006
Dated:	4/25/2023
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:
REVIVE CLINIC 13316 S WESTERN AVE OKLAHOMA CITY OK 73170 Phone #: (405) 703-8882 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
ERNEST BYRON FOSTER II	MD	31206
RONNIE KEITH	DO	1923

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