KIRSTIN RENAE FUDGE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****76

License Status

ACTIVE

Business

First Name

KIRSTIN

Middle

RENAE

Last Name

FUDGE

Business Name

KIRSTIN RENAE FUDGE

Original Issue Date

08/08/2025

Effective Date

01/20/2026

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60615

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/20/2026