RUSSENBERGER, NICHOLAS TYLER - Licensee Information

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Last Update: Monday, December 23, 2024 3:49 AM CST
Next Update: Monday, December 23, 2024 12:00 PM CST

RUSSENBERGER, NICHOLAS TYLER

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:	HARPER COUNTY COMMUNITY HOSPITAL 1003 HIGHWAY 64 NORTH BUFFALO OK 73834 Address last updated on 5/16/2024
Phone #:	(580) 735-2555
Fax #:
County:	HARPER
License:	5175
Dated:	11/6/2023
Expires:	3/31/2025
Temp. Ltr. Issued:	10/10/2023
Temp. Ltr. Expires:	11/16/2023
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:
HARPER COUNTY COMMUNITY HOSPITAL 1003 HIGHWAY 64 NORTH BUFFALO OK 73834 Phone #: (580) 735-2555 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
Tabitha D. Danley	DO	4025
ROBERT WILLIAM RADER	MD	21263
AARON S. SIZELOVE	DO	4958

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