KELSEY BRIANNE WICKENHAUSER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****52

License Status

ACTIVE

Business

First Name

KELSEY

Middle

BRIANNE

Last Name

WICKENHAUSER

Business Name

KELSEY BRIANNE WICKENHAUSER

Original Issue Date

08/05/2014

Effective Date

02/06/2026

Expiration Date

03/01/2028

City

BLOOMINGTON

State

Zip

61701

County

MCLEAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/06/2026