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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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MIMMS, LISA ANNE       
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: 9521 NICHOLS RD
OKLAHOMA CITY OK 73120

Address last updated on 2/2/2024
Phone #: (405) 821-2592
Fax #:
County: OKLAHOMA
License: 2213
Dated: 8/18/1994
Expires: 1/31/2025
Temp. Ltr. Issued: 7/22/1993
Temp. Ltr. Expires: 7/23/1994
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:
9521 NICHOLS RD
OKLAHOMA CITY OK 73120

Phone #: (405) 821-2592
Fax #:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
LAURA ASHLEY BLALOCK TA 3376
RANDI LEIGH BRANDT TA 1399
MICHAEL LOUIS BRUCE TA 2010
ANNA MARIA COSTELLO TA 3289
ALEXANDRIA GALE GOODRICH TA 2917
ANGELA GAYE LESTER TA 791
LESLIE HEIDI ROBERTS TA 3050
ALLISON GRACE SJONG TA 1189
MICHELLE CASEY TISDALE TA 1292

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