KIMBERLY D GILLOCK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****10

License Status

NOT RENEWED

Business

First Name

KIMBERLY

Middle

Last Name

GILLOCK

Business Name

KIMBERLY D GILLOCK

Original Issue Date

03/20/2008

Effective Date

03/20/2008

Expiration Date

03/01/2010

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

11/17/2010