KATHRYN DIANE TAILLIE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006036

License Status

ACTIVE

Business

First Name

KATHRYN

Middle

DIANE

Last Name

TAILLIE

Business Name

KATHRYN DIANE TAILLIE

Original Issue Date

10/06/2016

Effective Date

12/10/2023

Expiration Date

03/01/2026

City

MILWAUKEE

State

Zip

53226

Ever Disciplined

LastModifiedDate

12/03/2025