KELLY C COUSINS Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007097

License Status

ACTIVE

Business

First Name

KELLY

Middle

Last Name

COUSINS

Business Name

KELLY C COUSINS

Original Issue Date

07/10/2019

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

PARK RIDGE

State

Zip

60068

County

COOK

Ever Disciplined

LastModifiedDate

01/15/2026