KATHLEEN MARIE MONTGOMERY Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****55

License Status

ACTIVE

Business

First Name

KATHLEEN

Middle

MARIE

Last Name

MONTGOMERY

Business Name

KATHLEEN MARIE MONTGOMERY

BusinessDBA

KATHLEEN GATES

Original Issue Date

04/16/2021

Effective Date

04/10/2024

Expiration Date

05/31/2026

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026