AMANDA KELLY THATE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****05

License Status

ACTIVE

Business

First Name

AMANDA

Middle

KELLY

Last Name

THATE

Business Name

AMANDA KELLY THATE

Original Issue Date

11/10/2022

Effective Date

02/08/2024

Expiration Date

03/01/2026

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025