GRACE ASHLEY HENDERSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****66

License Status

NOT RENEWED

Business

First Name

GRACE

Middle

ASHLEY

Last Name

HENDERSON

Business Name

GRACE ASHLEY HENDERSON

Original Issue Date

11/12/2020

Effective Date

11/12/2020

Expiration Date

03/01/2022

City

PEORIA

State

Zip

61636

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022