KEITH EDWARD BALLINGER Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

INOPERATIVE

Business

First Name

KEITH

Middle

EDWARD

Last Name

BALLINGER

Business Name

KEITH EDWARD BALLINGER

Original Issue Date

10/21/2002

Effective Date

12/13/2023

Expiration Date

03/01/2026

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

12/03/2025