MACKENZIE N SHALLENBERGER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****77

License Status

ACTIVE

Business

First Name

MACKENZIE

Middle

Last Name

SHALLENBERGER

Business Name

MACKENZIE N SHALLENBERGER

Original Issue Date

03/28/2012

Effective Date

12/17/2025

Expiration Date

03/01/2028

City

PITTSFIELD

State

Zip

62363

County

PIKE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/17/2025