BECKY LYNN GORHAM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****71

License Status

NOT RENEWED

Business

First Name

BECKY

Middle

LYNN

Last Name

GORHAM

Business Name

BECKY LYNN GORHAM

Original Issue Date

02/06/2002

Effective Date

02/09/2016

Expiration Date

03/01/2018

City

LEWISTOWN

State

Zip

61542

County

FULTON

Ever Disciplined

LastModifiedDate

05/02/2018