AUTUMN KRYSTAL VALK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****94

License Status

NOT RENEWED

Business

First Name

AUTUMN

Middle

KRYSTAL

Last Name

VALK

Business Name

AUTUMN KRYSTAL VALK

Original Issue Date

08/16/2010

Effective Date

08/16/2010

Expiration Date

03/01/2012

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/01/2015