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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, April 26, 2024 4:03 AM CDT
Next Update: Friday, April 26, 2024 12:00 PM CDT

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DAVIS, SUSAN L
Practice Address: 1429 PENNSYLVANIA AVENUE
HARTSHORNE OK 74547

Address last updated on 2/16/2024
Phone #: (918) 297-2403
Fax #: (918) 297-2436
County: PITTSBURG
License: 533
Dated: 5/11/1989
Expires: 3/31/2025
Temp. Ltr. Issued: 7/3/2003
Temp. Ltr. Expires: 9/13/2003
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
8/20/2012 License Reinstated
5/17/2012 Suspension, License
2/1/2012 Complaint Citation
Board Filings and/or Orders:
05/17/2012
12/09/2011
12/09/2011
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
1429 PENNSYLVANIA AVENUE
HARTSHORNE OK 74547

Phone #: (918) 297-2403
Fax #: (918) 297-2436

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
ABDOLKARIM KHORASANCHIAN MD 12251
JOHNNY ALVIN ZELLMER MD 20237

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