SHANE WYATT KESLER Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****10

License Status

INOPERATIVE

Business

First Name

SHANE

Middle

WYATT

Last Name

KESLER

Business Name

SHANE WYATT KESLER

Original Issue Date

10/05/2012

Effective Date

10/05/2012

Expiration Date

03/01/2014

City

BLOOMINGTON

State

Zip

61705

County

MCLEAN

Ever Disciplined

LastModifiedDate

07/29/2013