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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Thursday, April 25, 2024 4:12 PM CDT
Next Update: Friday, April 26, 2024 2:50 AM CDT

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GREEN, TERESA DESHAWN
Practice Address: PINE RIDGE MENTAL HEALTHCARE
8422 N 123RD EAST AVENUE
OWASSO OK 74055

Address last updated on 3/15/2024
Phone #: (918) 858-4353
Fax #: (866) 246-2942
County: TULSA
License: 2962
Dated: 9/6/2018
Expires: 3/31/2025
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:
PINE RIDGE MENTAL HEALTHCARE
8422 N 123RD EAST AVENUE
OWASSO OK 74055

Phone #: (918) 858-4353
Fax #: (866) 246-2942

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
Aliyeah Ayadpoor DO 4736
DWIGHT JULIUS KORGAN MD 11178
NAVEEN NANDIGAMA KUMAR MD 20037

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