KATHRYN DIANE TAILLIE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****51

License Status

INOPERATIVE

Business

First Name

KATHRYN

Middle

DIANE

Last Name

TAILLIE

Business Name

KATHRYN DIANE TAILLIE

Original Issue Date

01/03/2017

Effective Date

12/10/2023

Expiration Date

03/01/2026

City

MILWAUKEE

State

Zip

53226

Ever Disciplined

LastModifiedDate

12/03/2025