LILLIAN GRACE SHIVELY Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****82

License Status

ACTIVE

Business

First Name

LILLIAN

Middle

GRACE

Last Name

SHIVELY

Business Name

LILLIAN GRACE SHIVELY

Original Issue Date

05/19/2021

Effective Date

01/05/2026

Expiration Date

03/01/2028

City

JERSEYVILLE

State

Zip

62052

County

JERSEY

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/05/2026