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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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MEDINA RIOS, YISSEL MEDINA       
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: THE CHICKASAW NATION MEDICAL CENTER
1921 STONECIPHER BLVD.
ADA OK 74820

Address last updated on 9/24/2024
Phone #: (580) 272-2555
Fax #:
County: PONTOTOC
License: 902
Dated:
Expires: 3/20/2025
Temp. Ltr. Issued: 10/24/2024
Temp. Ltr. Expires: 3/20/2025
License Type: Provisional Dietitian
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:
THE CHICKASAW NATION MEDICAL CENTER
1921 STONECIPHER BLVD.
ADA OK 74820

Phone #: (580) 272-2555
Fax #:
Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
MELISSA GAYLE VAVRICKA LD 1179

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