LIDDELL, RYAN ELIZABETH - 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

LIDDELL, RYAN ELIZABETH

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:	ASCENSION MEDICAL GROUP ST. JOHN PRIMARY CARE 13600 E. 86TH ST. N SUITE 100 OWASSO OK 74055 Address last updated on 7/15/2024
Phone #:	(918) 272-9313
Fax #:
County:	TULSA
License:	5242
Dated:	2/22/2024
Expires:	3/31/2025
License Type:	Physician Assistant
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	2026

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:
ASCENSION MEDICAL GROUP ST. JOHN PRIMARY CARE 13600 E. 86TH ST. N SUITE 100 OWASSO OK 74055 Phone #: (918) 272-9313 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:	Full/Part Time:
Primary Supervisor(s):
RAPHA A. S. WILEY	MD	28492

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