JORDAN LAYNE JACKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****79

License Status

NOT RENEWED

Business

First Name

JORDAN

Middle

LAYNE

Last Name

JACKSON

Business Name

JORDAN LAYNE JACKSON

Original Issue Date

10/17/2014

Effective Date

02/23/2016

Expiration Date

03/01/2018

City

ORLAND PARK

State

Zip

60467

County

COOK

Ever Disciplined

LastModifiedDate

05/10/2018