AMANDA NICOLE MCCORMICK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****42

License Status

ACTIVE

Business

First Name

AMANDA

Middle

NICOLE

Last Name

MCCORMICK

Business Name

AMANDA NICOLE MCCORMICK

Original Issue Date

09/21/2016

Effective Date

12/12/2023

Expiration Date

03/01/2026

City

MATTOON

State

Zip

61938

County

COLES

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025