NICOLE KENNEBECK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

ACTIVE

Business

First Name

NICOLE

Last Name

KENNEBECK

Business Name

NICOLE KENNEBECK

Original Issue Date

07/19/2022

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60614

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/06/2026