MYKALA PARIS SUPPLICE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085010120

License Status

NOT RENEWED

Business

First Name

MYKALA

Middle

PARIS

Last Name

SUPPLICE

Business Name

MYKALA PARIS SUPPLICE

Original Issue Date

10/06/2023

Effective Date

10/06/2023

Expiration Date

03/01/2024

City

GRAND RAPIDS

State

Zip

49525

Ever Disciplined

LastModifiedDate

02/05/2025