MARY ELIZABETH KING JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****44

License Status

NOT RENEWED

Business

First Name

MARY

Middle

ELIZABETH KING

Last Name

JOHNSON

Business Name

MARY ELIZABETH KING JOHNSON

Original Issue Date

03/09/2009

Effective Date

03/18/2010

Expiration Date

03/01/2012

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

04/16/2012