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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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KEUPEN, PETER WENDELIN       
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 CLINIC PRIMARY CARE NORMAN PORTER
950 N PORTER
NORMAN OK 73071-+641

Address last updated on 3/11/2024
Phone #: (405) 329-0121
Fax #: (405) 292-6099
County: CLEVELAND
License: 748
Dated: 4/1/1996
Expires: 3/31/2025
Temp. Ltr. Issued: 8/3/1995
Temp. Ltr. Expires: 8/3/1996
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:
MERCY CLINIC PRIMARY CARE NORMAN PORTER
950 N PORTER
NORMAN OK 73071-+641

Phone #: (405) 329-0121
Fax #: (405) 292-6099

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
LYDIA RENE BALLARD MD 18425
MICHELLE DEANN BARNES MD 29672
Jonathan A. Bryan DO 4706
STEPHEN EDWARD CONNERY MD 16184
ERICA DEARMAN DO 4895
JUSTIN ELLIOT FIELDS MD 25774
JOHN MICHAEL KRODEL MD 18046
KELLEY MARIE LOBB MD 26442
THOMAS HENRY MERRILL MD 14334
PAUL LLOYD PLUSQUELLEC JR MD 19357
CHRISTIAN CUMMINS SIECK MD 19870

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