SALLY JO BALLARD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****55

License Status

NOT RENEWED

Business

First Name

SALLY

Middle

Last Name

BALLARD

Business Name

SALLY JO BALLARD

Original Issue Date

03/13/2001

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

GOREVILLE

State

Zip

62939

County

JOHNSON

Ever Disciplined

LastModifiedDate

09/22/2010