KEVIN SHANE CLARK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003431

License Status

NOT RENEWED

Business

First Name

KEVIN SHANE

Last Name

CLARK

Business Name

KEVIN SHANE CLARK

Original Issue Date

02/09/2009

Effective Date

02/23/2016

Expiration Date

03/01/2018

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

05/10/2018