BENJAMIN G CLARK Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****60

License Status

ACTIVE

Business

First Name

BENJAMIN

Middle

Last Name

CLARK

Business Name

BENJAMIN G CLARK

Original Issue Date

08/20/2024

Effective Date

03/09/2026

Expiration Date

05/31/2028

City

WASHINGTON

State

Zip

61571

County

TAZEWELL

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/09/2026