KELLY CODERRE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

ACTIVE

Business

First Name

KELLY

Last Name

CODERRE

Business Name

KELLY CODERRE

Original Issue Date

04/09/2019

Effective Date

02/25/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60608

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/25/2026