JENNA MARIE JACKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****67

License Status

NOT RENEWED

Business

First Name

JENNA

Middle

MARIE

Last Name

JACKSON

Business Name

JENNA MARIE JACKSON

Original Issue Date

09/29/2021

Effective Date

01/23/2022

Expiration Date

03/01/2024

City

GRANITE CITY

State

Zip

62040

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025