KACIE HOLMAN SMITH 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

KACIE

Middle

HOLMAN

Last Name

SMITH

Business Name

KACIE HOLMAN SMITH

Original Issue Date

09/06/2012

Effective Date

09/06/2012

Expiration Date

03/01/2014

City

OAK PARK

State

Zip

60302

County

COOK

Ever Disciplined

LastModifiedDate

10/07/2014