SHIRLEY A MOODY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002240

License Status

NOT RENEWED

Business

First Name

SHIRLEY

Middle

Last Name

MOODY

Business Name

SHIRLEY A MOODY

Original Issue Date

04/15/2004

Effective Date

03/04/2010

Expiration Date

03/01/2012

City

SALEM

State

Zip

62881

County

MARION

Ever Disciplined

LastModifiedDate

04/11/2012