KYLE R CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****09

License Status

ACTIVE

Business

First Name

KYLE

Middle

Last Name

CLARK

Business Name

KYLE R CLARK

Original Issue Date

05/18/2020

Effective Date

02/08/2026

Expiration Date

03/01/2028

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/08/2026