TARA M JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****35

License Status

NOT RENEWED

Business

First Name

TARA

Middle

Last Name

JOHNSON

Business Name

TARA M JOHNSON

Original Issue Date

02/25/2009

Effective Date

02/25/2009

Expiration Date

03/01/2010

City

LITCHFIELD

State

Zip

62056

County

MONTGOMERY

Ever Disciplined

LastModifiedDate

09/23/2009