OKLAHOMA BOARD OF NURSING 2915 CLASSEN BOULEVARD - SUITE 524 - OKLAHOMA CITY, OKLAHOMA 73106?5437 - (405) 962?1800 - Fax (405) 962?1821 Written Verification of Oklahoma Licensure/Recognition Name: PRUITT, MARGARET LLOYD Address: 833 LYNWOOD LN BROKEN ARROW, OK 74011 License Type: Registered Nurse 1st Issued License Number: Expiration: License Status: Inactive Licensed by: Endorsement?In Education: School: Location: Type of Program: Baccalaureate - Nursing Graduation Date: Oklahoma schools hold state approval. Licensure Exam Date: Education and examination information may be considered primary source verification only if licensee was licensed by examination. If licensed by endorsement, education and examination information should be verified with original state of licensure. A certified copy will have the Seal of the Oklahoma Board of Nursing. No disciplinary action has been taken by the Oklahoma Board of Nursing. *First Issued Date does not imply continual licensure/ recognition status from that date forward. To expedite the written verificatianfof licensure/certification ?o?ma ?for all written verifications. Robin Bryant Administrative Technician Regulatory Services Divisio June 11, 2018 OKLAHOMA BOARD OF NURSE REGISTRATION AND NURSING EDUCATION FOR OFFICE USE ONLY: 2915 North Classen Blvd., Suite 524 Cert. ?7 Oklahoma City, Oklahoma 73106 Biennial Regis. Date - 405/525-2076 . Approved By Wu 0 Exam Required ??25 Endorsed From - . 71.} a uni-4c) OBNR 8. NIPPLICATION FOR CERTIFICATE av ENDORSEMENT AS A REGISTERED NURSE 77,; I hereby make application for a Certificate as a Registered Nurse in accordance with the statutes of? the State of Oklahoma (59 0.5. (USE TYPEWRITER IF AVAILABLE, OTHERWISE WRITE LEGIBLY OR PRINT CLEARLY IN DARK INK - BLUE OR BLACK ONLY) . Social Security No. 1. MY FULL name is ENE-LYN LLOYD First Middle Maiden Married 2. Mailing Address is SOUTH EUTLDING Box Number/Street Addfess TULSA (mom ERRED W- City State Zip Code Phone No. Morse code 3. Date of Birth-f- Place of Birth 55? Citizen USA: Yes (Mo-Day-Yri City and ta 4. Name and location of high school attendedS ML 5 'l Years high school completed Gra uate Date (Datei 5. Name and cos i of ursin from oh oh rad a UNNERSTN Katmai" rammed @1170?! Type of Program: Assoc__ Dial a Bacci Was p'rogram an external degre Date of' entering program {?wa Date of? completing program ?m List colleges TIP univers ties which yo?ldl have attend?l?inolude dates and degr?e d- . .1 conferred) KSITY UV KENTUCKY ?64" W15 6A. State or Country of ORIGINAL Ori in 1 License No. HMZQ In which state(s) did you write the exam:.nation? "Riff How many times did you write the examination? Dates written? Su? NW6 Noll; 68. Have you ever applied or written the examination in Oklahoma? Yes No If yes, specify if applied or written and indicate the date: 7. Have you ever been licensed in Oklahomalicensed previously in Oklahoma, name under which licensed 5 Other states in which you are or have been licensed: State Number 9 State Number State Number I .. 8. Are you practicing as an RN in Oklahoma? Yes No 0 If? yes, give name and address of? employer: 9. List names and addresses of employers during the past FIVE YEARS. If not employed submit name address of last Jio?er and date emplo?lr?nt 23:323. memo, he s. outgrow taped mm 7 WIN ANITA. as: KKESOE LDURNLLE i010? a? Rem AL w; E. was! NUT Ni Moi Have you ever been arrested for any offense or convicted of any offense including a deferred sentence within the past five years with the excepts/on of any offense NJ expunged under 63 0.5. 1931 2-410? YES No 11. Have you ever been convicted of a felony? Yes No '3 12. Have you ever been judicially declared incompetent? Yes Has your license ever been'revoked, suspended, surrendered, restricted, seed on probation, reprimanded, or currently under investigation? Yes No '1 IF ANSWER YES, PLEASE SUBMIT IN WRITING THE TYPE OF ACTION, LOCATION OF ACTION AND A DESCRIPTION OF THE ACTION. NOTE: YOUR NAME MUST APPEAR THE SAME IN ALL AREAS OF THIS APPLICATION INCLUDING THE AFFIDAVIT. TO BE COMPLETED BY GRADUATES OF FOREIGN NURSING SCHOOLS: Have you taken the Commission on Graduates of Foreign Nursing Schools ExaminationDid you pass the examination? Yes No If answer is yes, attach to this application a NDTARIZED COPY of the Certificate indicating you passed. Photograph must meet the following: Passport, 2" minimum 1" full E17 a: face View without glasses with eyes L54 clearly visible. 3 it; :3 Photograph must have been taken 3 Lu within the past two (2) years. s} This photograph was taken on the C3 of following date: {19?31an a: qt .J AFFIDAVIT (To be filled out by applicant before a Notary Public - Do NOT PRINT) SIGN FULL NAME, INCLUDING MIDDLE NAME (N0 INITIALS). IF NO MIDDLE NAME, INDICATE NMN. I'certify that I am the applicant who is referred to in the foregoing application for certificate as a Registered Nurse in the State of Oklahoma and that the statements therein contained are true in eve respect. . i Mimi [fifth ?Ami ?(Inuit Signature of applicant: 1 Mid 1e Maiyen Married Fir?s?j 95! Subscribed and sworn to before me, this or?) day of? 2?59: l9 QC) . bam/ Af?rm ?9 -- 932 My Commission Expires NoEary Public (SEAL) FORM Revised 10/1988 .- - . up . a: TL 7: DATE Tr TL 2 ?3 . b:?T F: T. I ?.Tr - I no 33L TEL pr': '37 TP PRDF STAFF FE Elf? JUL 1 21990 AUG 06 1990 n.1m1 -. NC T1-. FOHPLETE r'T'r DATE DATE TUI . KENTUCKY BOARD OF NURSING 4010 DUPONT CIRCLE. SUITE 430 RELEIJ LOUISVILLE. KENTUCKY 40207 . 06/25/90 M1129 90 VERIFICATION OF LICENSURE TO THE STATE OF OKLAHOMA THIS IS TO CERTIFY THAT MARGARET LLOYD PRUITT SOC SEC NO HAS ISSUED LICENSE NUMBER 1060910 DN 8/25/33 BY EXAMINATION TO BE A REGISTERED NURSE EXPIRATION DATE: 10/31/90 RECORDS DO NOT INDICATE PREVIOUS DISCIPLINARY ACTION OR INVESTIGATION PENDING ON A COMPLAINT. EDUCATIONAL PREPARATION IS BACCALAUREATE OR HIGHER NURSING PRUGRAN 76587 NAME UNIVERSITY OF - CITY LEXINGTON STATE KY DATE GRADUATED 1938 -- NURSING MEDICAL DHSTETRIC SURG. OF COMP RESULTS NURSING NURSING NURSING NURSING CHILDREN EXAM STANDARD SCORES 1970 NO. 763 A SHARON 5. EXECUTIVE DIRECTOR nurse ULQ Name-Nurse PRUITT, MARGARET LLOYD License# . . 0051567 Type options, 5=Disp1ay press Enter. th Entry Date Code Bieniel# 0; 1996/07/01 0814 1994/05/20 CO425006 h, 1992/07/01 K19243 _1 1990/07/12 F3=Exit F5=Refresh FB=Fold/Unfo1d uistory Received 1996/06/21 1994/05/20 1992/06/04 1990/07/12 Effective 1996/07/01 1994/07/01 1992/07/01 1990/07/12 1 Expiration 1996/06/30 1994/06/30 1992/06/30 Bottom F13=Prt 01d History UPDATE Nurse Employment JWARD Name-Nurse . . PRUITT, MARGARET LLOYD Licensa# . . . 0051567 Type information, press Enter. State . . . . $5 County . . . . Tulsa County Country . .. NSG . . . . . GI Full Time (35 hours) Field . . . . '66? School Health Typo . . . . . 331+ Staff Nurse Spec Coda. Comment: F3=Exit F5=Refresh F6=Audit Log F12=Cancel Qnursys QUICKCONFIIH QuickConfirm License Verification Report Primary Source Boards of Nursing Report Summary for MARGARET PRUITT ID: 40321886] Monday, June 11 2018 03:13:23 PM Disclaimer of Representations and Warranties Through a written agreement, participating individuai state boards of nursing designate Nursys as a primary source equivaient database. posts the information in Nursys when, and as, submitted by the individuai state boards of nursing. may not make any changes to the submitted information and disciaims any to update or verify such information as it is received from the individuai state boards of nursing. Nursys dispiays the dates on which a board of nursing updated its information in Nursys. This report is not suf?cient when appiying to another board of nursing for iicensure. Use the "Nurse License Verification for Endorsement" service to request the required verification of iicensure. Contact the board of nursing for detaiis about the Nurse Practice Act, which inciudes nurse scope of practice and priviieges and information about advanced nursing practice roies practice priviieges, prescription authority, dispensing priviieges 8: independent practice privileges). UNENCUHBERED means that the nurse has a fuii and unrestricted iicense to practice by the state board of nursing. License License License Original Issue License Expiration Compact Name on License Type State License Active Status Date Date Status MARGARET RN OKLAHOMA R0051567 NO EXPIRED 07i12i1990 NOT SUPPLIED NONE LLOYD License License License Original Issue License Expiration Name on License Type State License Active Status Date Date Compact Status PRUI1T, MARGARET RN KENTUCKY 1060910 NO EXPIRED 08f25i1988 10i31i'1996 - NONE Where can the nurse practice as an RN andlor Authorized to Practice in Based on the information provided to Nursys from the boards of nursing, this nurse does not have authorization to practice in any of the Nursys participating states. Non-participating: HI, MI. Non?participating boards of nursing do not submit iicensure data to Nursys. Please contact them for authorIZation to practice details. APRN authorization to practice details are not available. License type information RN: Reglstered Nurse I PN: Practical Nurse (aka Licensed Practical Nurse (LPN), Vocational Nurse (VN), Licensed Vocational Nurse CNP: Certi?ed Nurse Practitioner CNS: Nurse Specialist CNM: Certi?ed Nurse Midwife CRNA: Certified Registered Nurse Anesthetist License status Information I Unencumbered (full unrestricted license to practice) Cease BK Desist Denial of License Expired Other license action Probation Reprimand Restriction Revoked SUSpenslon 0 Voluntary agreement to refrain from practice 0 Voluntary Surrender Nurse Licensure Compact Informatlon licensure privilege: Authority to practice as a licensed nurse In a remote state under the current license Issued by the Individual's home state provided both states are party to the Nurse Llcensure Compact and the privilege Is not otherwise 0 Single state Ileense: A license Issued by a state board of nursing that authorizes practice only In the state of Issuance. I Privilege to Practice (FTP): ilcensure privilege Is the authority under the Nurse Llcensure Compact to practice nursing In any compact party state that Is not the state of Ilcensure. All party states have the authority In accordance with existing state due process law to take actions against the nurse's such as: revocation, suspension, probation or any other action which affects a nurse?s authorization to practice. mnuqnunhaqm 2018 National Councll of State Boards of Nursing Inc. All rights reserved.