KELLY DAWN BLISS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****18

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

DAWN

Last Name

BLISS

Business Name

KELLY DAWN BLISS

Original Issue Date

07/31/2009

Effective Date

04/04/2018

Expiration Date

03/01/2020

City

ALTON

State

Zip

62002

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020