KELLY LYNN MARTI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001884

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

LYNN

Last Name

MARTI

Business Name

KELLY LYNN MARTI

Original Issue Date

09/24/2002

Effective Date

01/30/2014

Expiration Date

03/01/2016

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Ever Disciplined

LastModifiedDate

04/25/2016