DAPHENE SMITH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002952

License Status

NOT RENEWED

Business

First Name

DAPHENE

Last Name

SMITH

Business Name

DAPHENE SMITH

Original Issue Date

03/13/2007

Effective Date

03/05/2020

Expiration Date

03/01/2022

City

OLIVETTE

State

Zip

63132

County

MISSOURI

Ever Disciplined

LastModifiedDate

07/27/2022

Case Number

2021006290

Action

Suspension

Discipline Start Date

11/08/2021

Discipline End Date

12/16/2021

Discipline Reason

Failure to file and/or pay Illinois state income taxes. Notice of tax deficiency release received from Department of Revenue on 12/20/2021.