CASEY A.T DIVELY Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

ADV PRACTICE NURSE CONTROL SUB

License Number

30*****82

License Status

ACTIVE

Business

First Name

CASEY

Middle

A.T

Last Name

DIVELY

Business Name

CASEY A.T DIVELY

Original Issue Date

05/10/2017

Effective Date

05/14/2024

Expiration Date

05/31/2026

City

TAYLORVILLE

State

Zip

62568

County

CHRISTIAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/02/2026