KIMBERLY NICOLE MALAVOLTI Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****24

License Status

ACTIVE

Business

First Name

KIMBERLY

Middle

NICOLE

Last Name

MALAVOLTI

Business Name

KIMBERLY NICOLE MALAVOLTI

Original Issue Date

03/16/2021

Effective Date

01/12/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/12/2026