SHIRLEY A MOODY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****56

License Status

NOT RENEWED

Business

First Name

SHIRLEY

Middle

Last Name

MOODY

Business Name

SHIRLEY A MOODY

Original Issue Date

02/07/2005

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Ever Disciplined

LastModifiedDate

02/10/2011