KELLY LEROY SPARKS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001973

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

LEROY

Last Name

SPARKS

Business Name

KELLY LEROY SPARKS

Original Issue Date

01/23/2003

Effective Date

12/26/2008

Expiration Date

03/01/2010

City

SYCAMORE

State

Zip

60178

County

DEKALB

Ever Disciplined

LastModifiedDate

04/01/2010