RICKY A POWELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000703

License Status

NOT RENEWED

Business

First Name

RICKY

Middle

Last Name

POWELL

Business Name

RICKY A POWELL

Original Issue Date

09/20/1995

Effective Date

02/06/2012

Expiration Date

03/01/2014

City

GLEN CARBON

State

Zip

62034

County

MADISON

Ever Disciplined

LastModifiedDate

04/08/2014