KELLY ANNE SUPPLE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036098841

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

ANNE

Last Name

SUPPLE

Suffix

Business Name

KELLY ANNE SUPPLE MD

Original Issue Date

08/20/1998

Effective Date

10/06/2011

Expiration Date

07/31/2014

City

BRADFORD

State

Zip

16701

County

PENNSYLVANIA

Ever Disciplined

LastModifiedDate

07/28/2015

Case Number

2015004647

Action

Refuse To Renew

Discipline Start Date

07/17/2015

Discipline Reason

due to a sister-state discipline in the state of Washington.