KATIE R ASP Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****20

License Status

INOPERATIVE

Business

First Name

KATIE

Middle

Last Name

ASP

Business Name

KATIE R ASP

Original Issue Date

07/14/2011

Effective Date

02/05/2014

Expiration Date

03/01/2016

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

02/05/2014