PATRICIA GRACIELA BLACKBURN Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****62

License Status

ACTIVE

Business

First Name

PATRICIA

Middle

GRACIELA

Last Name

BLACKBURN

Business Name

PATRICIA GRACIELA BLACKBURN

Original Issue Date

10/16/2015

Effective Date

12/29/2025

Expiration Date

03/01/2028

City

OGLESBY

State

Zip

61348

County

LA SALLE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/29/2025