STACIA LYNN CHEADLE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****05

License Status

NOT RENEWED

Business

First Name

STACIA

Middle

LYNN

Last Name

CHEADLE

Business Name

STACIA LYNN CHEADLE

Original Issue Date

10/02/2012

Effective Date

01/29/2014

Expiration Date

03/01/2016

City

CHARLESTON

State

Zip

61920

County

COLES

Ever Disciplined

LastModifiedDate

05/22/2017