TRACIE R KELLY Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****10

License Status

INACTIVE

Business

First Name

TRACIE R

Last Name

KELLY

Business Name

TRACIE R KELLY

Original Issue Date

06/29/2020

Effective Date

03/21/2024

Expiration Date

05/31/2026

City

OTTAWA

State

Zip

61350

County

LA SALLE

Delegated Controlled Substance Schedule

IV V

Ever Disciplined

LastModifiedDate

05/15/2025