MALLORY JEAN KELLY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

ACTIVE

Business

Title

First Name

MALLORY

Middle

JEAN

Last Name

KELLY

Business Name

MALLORY JEAN KELLY MD

Original Issue Date

02/01/2018

Effective Date

04/13/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/13/2023