STREET, WILLIE JESSE - 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

STREET, WILLIE JESSE

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:	PHILLIPS 66 CORPORATION PONCA CITY REFINERY HEALTH SERVICES 1000 S. PINE SOUTH TOWER PONCA CITY OK 74601 Address last updated on 4/17/2024
Phone #:	(580) 767-6360
Fax #:	(580) 767-2006
County:	KAY
License:	631
Dated:	2/27/1993
Expires:	3/31/2025
Temp. Ltr. Issued:	12/3/1992
Temp. Ltr. Expires:	2/27/1993
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:
PHILLIPS 66 CORPORATION PONCA CITY REFINERY HEALTH SERVICES 1000 S. PINE SOUTH TOWER PONCA CITY OK 74601 Phone #: (580) 767-6360 Fax #: (580) 767-2006

Hospital Privileges:

None listed

Name:	Type:	License Number:
Primary Supervisor(s):
JAMES MICHAEL CARVER	MD	17000
WILLIAM CHARLES PARSONS	MD	15226

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