KRISTIAN HALE JENSEN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****29

License Status

INOPERATIVE

Business

First Name

KRISTIAN

Middle

HALE

Last Name

JENSEN

Business Name

KRISTIAN HALE JENSEN

Original Issue Date

08/12/2009

Effective Date

12/24/2019

Expiration Date

03/01/2022

City

DECATUR

State

Zip

62526

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/03/2022