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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, April 28, 2024 6:57 PM CDT
Next Update: Monday, April 29, 2024 2:50 AM CDT

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JENISON, DORETTA R
Practice Address: SSM
2825 PARKLAWN DR
MIDWEST CITY OK 73110

Address last updated on 2/23/2024
Phone #: (405) 610-8363
Fax #:
County: OKLAHOMA
License: 3156
Dated: 2/11/2020
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:
SSM
2825 PARKLAWN DR
MIDWEST CITY OK 73110

Phone #: (405) 610-8363
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
Khabbab Amin DO 6871
JOSEPH CLIFTON BROOME MD 23006

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