JENISE A CLARK Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****61

License Status

INOPERATIVE

Business

First Name

JENISE

Middle

Last Name

CLARK

Business Name

JENISE A CLARK

Original Issue Date

06/07/2002

Effective Date

12/19/2011

Expiration Date

03/01/2014

City

HERRIN

State

Zip

62948

County

WILLIAMSON

Ever Disciplined

LastModifiedDate

03/03/2014