KIMBROUGH, SAMUEL WADE - 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

KIMBROUGH, SAMUEL WADE

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:	OKLAHOMA NEUROLOGY CENTER 1705 RENAISSANCE BLVD STE 120 EDMOND OK 73013 Address last updated on 7/1/2024
Phone #:	(405) 844-8572
Fax #:
County:	OKLAHOMA
License:	5029
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:
OKLAHOMA NEUROLOGY CENTER 1705 RENAISSANCE BLVD STE 120 EDMOND OK 73013 Phone #: (405) 844-8572 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:	Full/Part Time:
Primary Supervisor(s):
ROBERT JAMES TYNDALL	MD	18639

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