ANDREA KATHRYN STOUT Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****84

License Status

ACTIVE

Business

First Name

ANDREA

Middle

KATHRYN

Last Name

STOUT

Business Name

ANDREA KATHRYN STOUT

Original Issue Date

11/29/2011

Effective Date

12/08/2025

Expiration Date

03/01/2028

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/08/2025