KELLY DIETRICK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085011805

License Status

ACTIVE

Business

First Name

KELLY

Last Name

DIETRICK

Business Name

KELLY DIETRICK

Original Issue Date

10/28/2025

Effective Date

01/12/2026

Expiration Date

03/01/2028

City

ARLINGTON HEIGHTS

State

Zip

60004

Ever Disciplined

LastModifiedDate

01/12/2026