KRISTIN MARIE BLANKENSHIP Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****63

License Status

NOT RENEWED

Business

First Name

KRISTIN

Middle

MARIE

Last Name

BLANKENSHIP

Business Name

KRISTIN MARIE BLANKENSHIP

Original Issue Date

03/21/2014

Effective Date

03/21/2014

Expiration Date

03/01/2016

City

SPRIINGFIELD

State

Zip

62794

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/25/2016