KELLY LEROY SPARKS - Physician Assistant License in Illinois | # 085001973

KELLY LEROY SPARKS

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001973

License Status

NOT RENEWED

Business

N

First Name

KELLY

Middle

LEROY

Last Name

SPARKS

Business Name

KELLY LEROY SPARKS

Original Issue Date

01/23/2003

Effective Date

12/26/2008

Expiration Date

03/01/2010

State

IL

Ever Disciplined

N

LastModifiedDate

04/01/2010