KIM KEITH WIESE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006503

License Status

ACTIVE

Business

First Name

KIM

Middle

KEITH

Last Name

WIESE

Business Name

KIM KEITH WIESE

Original Issue Date

02/08/2018

Effective Date

12/05/2025

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

12/05/2025