AMANDA KELLY THATE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009264

License Status

ACTIVE

Business

First Name

AMANDA

Middle

KELLY

Last Name

THATE

Business Name

AMANDA KELLY THATE

Original Issue Date

09/24/2022

Effective Date

02/08/2024

Expiration Date

03/01/2026

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

12/03/2025