CARISSA LYNN PARDEKOOPER 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

CARISSA

Middle

LYNN

Last Name

PARDEKOOPER

Business Name

CARISSA LYNN PARDEKOOPER

Original Issue Date

10/08/2014

Effective Date

01/30/2020

Expiration Date

03/01/2022

City

PEORIA

State

Zip

61614

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022