ELEN SHELLEY PUCKETT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****73

License Status

NOT RENEWED

Business

First Name

ELEN

Middle

SHELLEY

Last Name

PUCKETT

Business Name

ELEN SHELLEY PUCKETT

Original Issue Date

10/17/2017

Effective Date

10/17/2017

Expiration Date

03/01/2018

City

JOLIET

State

Zip

60435

County

WILL

Ever Disciplined

LastModifiedDate

05/10/2018