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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, May 6, 2024 6:57 PM CDT
Next Update: Tuesday, May 7, 2024 2:50 AM CDT

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MIETUS, NICHOLAS ALBERT
Practice Address: NORTHERN OKLAHOMA DERMATOLOGY LLC
309 SE FRANK PHILLIPS BLVD
BARTLESVILLE OK 74003

Address last updated on 3/27/2024
Phone #: (918) 241-8888
Fax #:
County: WASHINGTON
License: 2854
Dated: 1/3/2018
Expires: 3/31/2025
Temp. Ltr. Issued: 1/18/2018
Temp. Ltr. Expires: 3/8/2018
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
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:
NORTHERN OKLAHOMA DERMATOLOGY LLC
309 SE FRANK PHILLIPS BLVD
BARTLESVILLE OK 74003

Phone #: (918) 241-8888
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
RAYMOND LOUIS CORNELISON JR MD 9074
TAMARA LYNN HILL MD 17349

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