KRISTA DECOURSEY WASHBURN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****13

License Status

NOT RENEWED

Business

First Name

KRISTA

Middle

DECOURSEY

Last Name

WASHBURN

Business Name

KRISTA DECOURSEY WASHBURN

Original Issue Date

09/18/2015

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

PEORIA

State

Zip

61604

County

COOK

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

07/27/2022