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Last Update: Sunday, May 19, 2024 1:49 PM CDT
Next Update: Sunday, May 19, 2024 4:30 PM CDT
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LEWIS, TARA MIRANDA
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| Practice Address: |
2510 CHICKASAW BLVD
ARDMORE OK 73401
Address last updated on 2/12/2024 |
| Phone #: |
(580) 226-8181 |
| Fax #: |
|
| County: |
CARTER |
| License: |
1659 |
| Dated: |
10/18/2007 |
| Expires: |
3/31/2025 |
|
Temp.
Ltr.
Issued:
|
8/31/2007 |
|
Temp.
Ltr.
Expires:
|
11/3/2007 |
| License Type: |
Physician Assistant |
| Specialty: |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| CME Year: |
2025 |
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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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Hospital Privileges:
Mercy Hospital Healdton (fmly Healdton Municipal)
Healdton, OK
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Primary Supervisor(s):
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| Name: |
Type: |
License Number: |
Full/Part Time: |
|
CONNIE WILSON
|
DO |
3394 |
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