KELLY LEROY SPARKS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

LEROY

Last Name

SPARKS

Business Name

KELLY LEROY SPARKS

Original Issue Date

04/24/2003

Effective Date

01/15/2009

Expiration Date

03/01/2010

City

SYCAMORE

State

Zip

60178

County

DEKALB

Ever Disciplined

LastModifiedDate

07/08/2009