ELIJAH BOONE CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****68

License Status

ACTIVE

Business

First Name

ELIJAH

Middle

BOONE

Last Name

CLARK

Business Name

ELIJAH BOONE CLARK

Original Issue Date

12/15/2022

Effective Date

01/07/2026

Expiration Date

03/01/2028

City

OAKWOOD

State

Zip

61858

County

VERMILION

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/07/2026