KELLY ELIZABETH STOLL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****65

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

ELIZABETH

Last Name

STOLL

Business Name

KELLY ELIZABETH STOLL

Original Issue Date

07/07/2010

Effective Date

07/07/2010

Expiration Date

03/01/2012

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

11/20/2015