MEKENNA FREDERICK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****41

License Status

ACTIVE

Business

First Name

MEKENNA

Last Name

FREDERICK

Business Name

MEKENNA FREDERICK

Original Issue Date

09/04/2025

Effective Date

12/15/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60660

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/15/2025