KELLEN LANE KREGER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****81

License Status

NOT RENEWED

Business

First Name

KELLEN

Middle

LANE

Last Name

KREGER

Business Name

KELLEN LANE KREGER

Original Issue Date

04/13/2020

Effective Date

03/02/2022

Expiration Date

03/01/2024

City

CRESTWOOD

State

Zip

60418

County

COOK

Ever Disciplined

LastModifiedDate

02/05/2025