KELLY LYNN MARTI Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****27

License Status

INOPERATIVE

Business

First Name

KELLY

Middle

LYNN

Last Name

MARTI

Business Name

KELLY LYNN MARTI

Original Issue Date

10/17/2002

Effective Date

01/30/2014

Expiration Date

03/01/2016

City

MARYVILLE

State

Zip

62062

County

MADISON

Ever Disciplined

LastModifiedDate

11/12/2014