KELLIE ELIZABETH BIBB Advanced Practice Nurse License verification

Business Entity

INACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****19

License Status

INACTIVE

Business

First Name

KELLIE

Middle

ELIZABETH

Last Name

BIBB

Business Name

KELLIE ELIZABETH BIBB

Original Issue Date

12/21/2015

Effective Date

04/12/2018

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2018