BERNARD V KENNEDY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

NOT RENEWED

Business

First Name

BERNARD

Middle

Last Name

KENNEDY

Business Name

BERNARD V KENNEDY

Original Issue Date

08/22/2019

Effective Date

01/22/2020

Expiration Date

03/01/2022

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022