DONALD L CLARK III Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****67

License Status

ACTIVE

Business

First Name

DONALD

Middle

Last Name

CLARK III

Business Name

DONALD L CLARK III

Original Issue Date

09/19/2019

Effective Date

03/11/2026

Expiration Date

05/31/2028

City

CARBONDALE

State

Zip

62901

County

JACKSON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/11/2026