TYSON RAND KINNICK 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

TYSON

Middle

RAND

Last Name

KINNICK

Business Name

TYSON RAND KINNICK

Original Issue Date

06/14/2016

Effective Date

02/05/2020

Expiration Date

03/01/2022

City

DUNLAP

State

Zip

61525

Ever Disciplined

LastModifiedDate

01/03/2022