AUSTIN GRAHAM KENNEBECK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****90

License Status

ACTIVE

Business

First Name

AUSTIN

Middle

GRAHAM

Last Name

KENNEBECK

Business Name

AUSTIN GRAHAM KENNEBECK

Original Issue Date

11/25/2024

Effective Date

02/04/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2026