KELLY C COUSINS Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****91

License Status

ACTIVE

Business

First Name

KELLY

Middle

Last Name

COUSINS

Business Name

KELLY C COUSINS

Original Issue Date

07/24/2019

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

PARK RIDGE

State

Zip

60068

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/15/2026