HEATHER FUNDERBURG KIRKPATRICK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****90

License Status

NOT RENEWED

Business

First Name

HEATHER

Middle

FUNDERBURG

Last Name

KIRKPATRICK

Business Name

HEATHER FUNDERBURG KIRKPATRICK

Original Issue Date

03/28/2016

Effective Date

03/28/2016

Expiration Date

03/01/2018

City

MARYVILLE

State

Zip

62062

County

MADISON

Ever Disciplined

LastModifiedDate

05/10/2018