KIRSTIN RENAE FUDGE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085011392

License Status

ACTIVE

Business

First Name

KIRSTIN

Middle

RENAE

Last Name

FUDGE

Business Name

KIRSTIN RENAE FUDGE

Original Issue Date

07/14/2025

Effective Date

01/13/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/13/2026