MALLARD, JORDAN OLIVIA NICOLE - Licensee Information

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

MALLARD, JORDAN OLIVIA NICOLE

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:	MERCY ORTHOPEDIC SURGERY CLINIC - OKC 5600 SE 67TH STREET, SUITE 200 OKLAHOMA CITY OK 73135 Address last updated on 10/30/2024
Phone #:	(405) 455-4020
Fax #:
County:	OKLAHOMA
License:	5489
Dated:
Expires:	3/20/2025
Temp. Ltr. Issued:	11/6/2024
Temp. Ltr. Expires:	3/20/2025
License Type:	Physician Assistant
Specialty:

Status:	Active
Status Class:	Temporary
Restricted to:
CME Year:	0

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:
MERCY ORTHOPEDIC SURGERY CLINIC - OKC 5600 SE 67TH STREET, SUITE 200 OKLAHOMA CITY OK 73135 Phone #: (405) 455-4020 Fax #:

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
GREG EDWARD HALKO	MD	24394
DAVID BENJAMIN PARKER	MD	34707
GINA PROVENZANO	MD	42869

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