KRISTIN LEIGH WILLIS Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

INOPERATIVE

Business

First Name

KRISTIN

Middle

LEIGH

Last Name

WILLIS

Business Name

KRISTIN LEIGH WILLIS

Original Issue Date

07/21/2011

Effective Date

01/30/2020

Expiration Date

03/01/2022

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/03/2022