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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, November 23, 2024 3:48 AM CST
Next Update: Saturday, November 23, 2024 12:00 PM CST

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DAVIS, SUSAN L       
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: 1429 PENNSYLVANIA AVENUE
HARTSHORNE OK 74547

Address last updated on 2/16/2024
Phone #: (918) 297-2403
Fax #: (918) 297-2436
County: PITTSBURG
License: 533
Dated: 5/11/1989
Expires: 3/31/2025
Temp. Ltr. Issued: 7/3/2003
Temp. Ltr. Expires: 9/13/2003
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
8/20/2012 License Reinstated
5/17/2012 Suspension, License
2/1/2012 Complaint Citation
Board Filings and/or Orders:
05/17/2012
12/09/2011
12/09/2011
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
1429 PENNSYLVANIA AVENUE
HARTSHORNE OK 74547

Phone #: (918) 297-2403
Fax #: (918) 297-2436

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
ABDOLKARIM KHORASANCHIAN MD 12251
JOHNNY ALVIN ZELLMER MD 20237

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