KEVIN SHANE CLARK Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

INOPERATIVE

Business

First Name

KEVIN SHANE

Last Name

CLARK

Business Name

KEVIN SHANE CLARK

Original Issue Date

11/06/2009

Effective Date

02/23/2016

Expiration Date

03/01/2018

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

05/02/2018