MELISSA MARGARET CROCKER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****51

License Status

NOT RENEWED

Business

First Name

MELISSA

Middle

MARGARET

Last Name

CROCKER

Business Name

MELISSA MARGARET CROCKER

Original Issue Date

01/09/2020

Effective Date

01/09/2020

Expiration Date

03/01/2022

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022