JILL WISE CHILDERS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002106

License Status

NOT RENEWED

Business

First Name

JILL

Middle

WISE

Last Name

CHILDERS

Business Name

JILL WISE CHILDERS

Original Issue Date

10/06/2003

Effective Date

02/17/2010

Expiration Date

03/01/2012

City

TUNNEL HILL

State

Zip

62972

County

JOHNSON

Ever Disciplined

LastModifiedDate

04/11/2012