KELLY DIETRICK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****49

License Status

ACTIVE

Business

First Name

KELLY

Last Name

DIETRICK

Business Name

KELLY DIETRICK

Original Issue Date

12/01/2025

Effective Date

01/15/2026

Expiration Date

03/01/2028

City

HUNTLEY

State

Zip

60142

County

MCHENRY

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/15/2026