WALLACE, JENNIFER LINDSEY - Licensee Information

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WALLACE, JENNIFER LINDSEY

Practice Address:	MOORE PRIMARY CARE 1400 SE 4TH STREET #H MOORE OK 73160 Address last updated on 3/30/2012
Phone #:	(405) 799-7400
Fax #:
County:	CLEVELAND
License:	2113
Dated:	4/1/2012
Expires:	3/31/2013
Temp. Ltr. Issued:	1/3/2012
Temp. Ltr. Expires:	4/1/2012
License Type:	Physician Assistant
Specialty:

Status:	Inactive
Status Class:	Expired License
Restricted to:
CME Year:	0

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 STREET #H MOORE OK 73160 Phone #: (405) 799-7400 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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