TARA M JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003404

License Status

NOT RENEWED

Business

First Name

TARA

Middle

Last Name

JOHNSON

Business Name

TARA M JOHNSON

Original Issue Date

01/06/2009

Effective Date

01/06/2009

Expiration Date

03/01/2010

City

LITCHFIELD

State

Zip

62056

County

MONTGOMERY

Ever Disciplined

LastModifiedDate

04/01/2010