KATIE FOUNTAIN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085012097

License Status

ACTIVE

Business

First Name

KATIE

Last Name

FOUNTAIN

Business Name

KATIE FOUNTAIN

Original Issue Date

02/10/2026

Effective Date

02/10/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60606

Ever Disciplined

LastModifiedDate

02/10/2026