NATHANIEL EDWIN CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****07

License Status

ACTIVE

Business

First Name

NATHANIEL

Middle

EDWIN

Last Name

CLARK

Business Name

NATHANIEL EDWIN CLARK

Original Issue Date

03/17/2010

Effective Date

02/03/2026

Expiration Date

03/01/2028

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/03/2026