KRISTEN ELIZABETH POLK Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****12

License Status

INOPERATIVE

Business

First Name

KRISTEN

Middle

ELIZABETH

Last Name

POLK

Business Name

KRISTEN ELIZABETH POLK

Original Issue Date

03/03/2021

Effective Date

01/10/2022

Expiration Date

03/01/2024

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

12/14/2023