KELLY KAY KERKSICK OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****21

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

KAY

Last Name

KERKSICK

Suffix

Business Name

KELLY KAY KERKSICK OD

Original Issue Date

06/26/2002

Effective Date

03/03/2016

Expiration Date

03/31/2018

City

COLUMBIA

State

Zip

62236

County

MONROE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018