JEREMY KEITH MATHENIA Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****15

License Status

ACTIVE

Business

First Name

JEREMY

Middle

KEITH

Last Name

MATHENIA

Business Name

JEREMY KEITH MATHENIA

Original Issue Date

12/20/2011

Effective Date

12/17/2025

Expiration Date

03/01/2028

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

12/17/2025