The holder whose full name is Blackwell, Kimberly Suzzane,come from Fortville IN,hold the Physician Assistant - Prescriptive Authority license(NO.10000609A) which status is Active.
| Name | Blackwell, Kimberly Suzzane |
|---|---|
| License Number | 10000609A |
| License Type | Physician Assistant - Prescriptive Authority |
| License Status | Active |
| City | Fortville |
| State | IN |