MCKENZIE K MANGUN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****50

License Status

ACTIVE

Business

First Name

MCKENZIE

Middle

Last Name

MANGUN

Business Name

MCKENZIE K MANGUN

Original Issue Date

02/11/2026

Effective Date

02/11/2026

Expiration Date

03/01/2028

City

ROANOKE

State

Zip

61561

County

WOODFORD

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/11/2026