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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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HEINZE, ALEXANDRIA       
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: UTICA PARK CLINIC
1145 SOUTH UTICA SUITE 202
TULSA OK 74104

Address last updated on 5/3/2024
Phone #: (918) 579-3130
Fax #:
County: TULSA
License: 5254
Dated: 4/24/2024
Expires: 3/31/2025
Temp. Ltr. Issued: 4/19/2024
Temp. Ltr. Expires: 5/16/2024
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:
UTICA PARK CLINIC
1145 SOUTH UTICA SUITE 202
TULSA OK 74104

Phone #: (918) 579-3130
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
MELANIE NYEH KETCHANDJI MD 31609

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