MALLORY LANE HENRY Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085008076

License Status

ACTIVE

Business

First Name

MALLORY

Middle

LANE

Last Name

HENRY

Business Name

MALLORY LANE HENRY

Original Issue Date

11/09/2020

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

SAINT LOUIS

State

Zip

63122

Ever Disciplined

LastModifiedDate

12/03/2025