KELLY JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005399

License Status

NOT RENEWED

Business

First Name

KELLY

Last Name

JOHNSON

Business Name

KELLY JOHNSON

Original Issue Date

02/04/2015

Effective Date

01/28/2020

Expiration Date

03/01/2022

City

HERRIN

State

Zip

62948

County

WILLIAMSON

Ever Disciplined

LastModifiedDate

07/27/2022