PROVENCHER, ERRYN C - Licensee Information

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Next Update: Tuesday, May 14, 2024 2:50 AM CDT

PROVENCHER, ERRYN C

Practice Address:	MOORE PRIMARY CARE 1400 SE 4TH ST STE H MOORE OK 73160 Address last updated on 3/16/2016
Phone #:	(405) 798-7400
Fax #:
County:	CLEVELAND
License:	2610
Dated:	1/14/2016
Expires:	3/31/2017
Temp. Ltr. Issued:	12/29/2015
Temp. Ltr. Expires:	3/11/2016
License Type:	Physician Assistant
Specialty:

Status:	Inactive
Status Class:	Expired License
Restricted to:
CME Year:	2017

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:
MOORE PRIMARY CARE 1400 SE 4TH ST STE H MOORE OK 73160 Phone #: (405) 798-7400 Fax #:

Hospital Privileges:

None listed

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Oklahoma State Board of Medical Licensure and Supervision :: 101 NE 51st St, Oklahoma City, OK 73105-1821
Main Number: (405) 962-1400 :: Fax: (405) 962-1440 :: Complaints outside 405 area code: 1-800-381-4519
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