KEITH EDWARD BALLINGER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001872

License Status

ACTIVE

Business

First Name

KEITH

Middle

EDWARD

Last Name

BALLINGER

Business Name

KEITH EDWARD BALLINGER

Original Issue Date

09/24/2002

Effective Date

12/13/2023

Expiration Date

03/01/2026

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

12/03/2025