KELLI ELAINE GROOMER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004349

License Status

NOT RENEWED

Business

First Name

KELLI

Middle

ELAINE

Last Name

GROOMER

Business Name

KELLI ELAINE GROOMER

Original Issue Date

07/12/2012

Effective Date

02/08/2016

Expiration Date

03/01/2018

City

BELVIDERE

State

Zip

61008

County

BOONE

Ever Disciplined

LastModifiedDate

05/10/2018