JACOB PAUL CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009751

License Status

ACTIVE

Business

First Name

JACOB

Middle

PAUL

Last Name

CLARK

Business Name

JACOB PAUL CLARK

Original Issue Date

07/01/2023

Effective Date

01/30/2026

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

01/30/2026