Oklahoma State SealOklahoma State Seal
Oklahoma Board of Medical Licensure and Supervision

Search Results

Last Update: Thursday, May 16, 2024 9:35 AM CDT
Next Update: Thursday, May 16, 2024 12:00 PM CDT

Return to Search Licensees page

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

Return to Search Licensees page