AUDREY KYANA LA'COLE FIELDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****78

License Status

NOT RENEWED

Business

First Name

AUDREY

Middle

KYANA LA'COLE

Last Name

FIELDS

Business Name

AUDREY KYANA LA'COLE FIELDS

Original Issue Date

08/15/2018

Effective Date

08/15/2018

Expiration Date

01/31/2022

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/09/2022