KELLY ANNE SUPPLE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

ANNE

Last Name

SUPPLE

Suffix

Business Name

KELLY ANNE SUPPLE MD

Original Issue Date

10/14/1998

Effective Date

10/26/2011

Expiration Date

07/31/2014

City

BRADFORD

State

Zip

16701

County

PENNSYLVANIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014