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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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SMITH, CONNIE SUE
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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.
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| Practice Address: |
FIVE STAR INTERLOCAL CO-OP
1405 E MOSES
CUSHING OK 74023
Address last updated on 1/31/2024 |
| Phone #: |
(918) 225-5600 |
| Fax #: |
(918) 225-3026 |
| County: |
PAYNE |
| License: |
596 |
| Dated: |
10/16/1997 |
| Expires: |
1/31/2025 |
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Temp.
Ltr.
Issued:
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7/31/1997 |
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Temp.
Ltr.
Expires:
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11/22/1997 |
| License Type: |
Physical Therapist Assistant |
| Specialty: |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| CME Year: |
2026 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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Primary Supervisor(s):
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| Name: |
Type: |
License Number: |
Full/Part Time: |
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SHELLEY KAY LANE
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PT |
1484 |
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