KATIE R ASP Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003497

License Status

NOT RENEWED

Business

First Name

KATIE

Middle

Last Name

ASP

Business Name

KATIE R ASP

Original Issue Date

07/07/2009

Effective Date

02/05/2014

Expiration Date

03/01/2016

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/25/2016