KIMBERLY NICOLE CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****47

License Status

ACTIVE

Business

First Name

KIMBERLY

Middle

NICOLE

Last Name

CLARK

Business Name

KIMBERLY NICOLE CLARK

Original Issue Date

01/08/2020

Effective Date

12/08/2025

Expiration Date

03/01/2028

City

WHEATON

State

Zip

60189

County

DUPAGE

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

12/08/2025