BALLESTEROS, RAFFY PRADO - 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

BALLESTEROS, RAFFY PRADO

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:	JACK C. MONTGOMERY VA MEDICAL CENTER 1011 HONOR HEIGHTS DRIVE MUSKOGEE OK 74401 Address last updated on 12/17/2024
Phone #:	(918) 252-8000 x2996
Fax #:	(918) 577-3910
County:	MUSKOGEE
License:	2054
Dated:	6/26/1993
Expires:	1/31/2026
Temp. Ltr. Issued:	8/13/1992
Temp. Ltr. Expires:	6/26/1993
License Type:	Physical Therapist
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	2026

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:
JACK C. MONTGOMERY VA MEDICAL CENTER 1011 HONOR HEIGHTS DRIVE MUSKOGEE OK 74401 Phone #: (918) 252-8000 x2996 Fax #: (918) 577-3910

Name:	Type:	License Number:
Primary Supervisees(s):
JAMES HEROLD MOORE	TA	262
KRISTINA DIANN MOSTELLER	TA	425
JOHNSON LOUIS PARACKAL	TA	1535

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