EMILY FAY STREET Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****18

License Status

ACTIVE

Business

First Name

EMILY

Middle

FAY

Last Name

STREET

Business Name

EMILY FAY STREET

Original Issue Date

02/19/2025

Effective Date

02/10/2026

Expiration Date

03/01/2028

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/10/2026