KATHERINE MARY LONG Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****60

License Status

INOPERATIVE

Business

First Name

KATHERINE

Middle

MARY

Last Name

LONG

Business Name

KATHERINE MARY LONG

Original Issue Date

04/27/2021

Effective Date

02/23/2022

Expiration Date

03/01/2024

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

12/06/2023