KIERSTEN M REVORD (Credential# 1207525) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2016. The license expiration date date is March 31, 2017. The license status is INACTIVE.
KIERSTEN M REVORD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.003068. The credential type is physician assistant. The effective date is April 1, 2016. The expiration date is March 31, 2017. The business address is 51 Glendale Rd, Southampton, MA 01073-9461. The current status is inactive.
| Licensee Name | KIERSTEN M REVORD |
| Credential ID | 1207525 |
| Credential Number | 23.003068 |
| Credential Type | Physician Assistant |
| Business Address |
51 Glendale Rd Southampton MA 01073-9461 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2014-03-13 |
| Effective Date | 2016-04-01 |
| Expiration Date | 2017-03-31 |
| Refresh Date | 2017-07-04 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1211788 | CSP.0056847 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2014-04-02 | 2015-03-01 - 2017-02-28 | INACTIVE |
| Street Address | 51 GLENDALE RD |
| City | SOUTHAMPTON |
| State | MA |
| Zip Code | 01073-9461 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Marisol Franco | 17 Katelyn Way, Southampton, MA 01073 | Real Estate Salesperson | 2020-06-11 ~ 2021-05-31 |
| Wendy J Allen | 11 Russellville Road, Southampton, MA 01073 | Notary Public Appointment | 2020-05-01 ~ 2025-04-30 |
| Gwen Laprade | 11 Karen Lane, Southampton, MA 01073 | Tax Preparer/facilitator Permit | 2020-02-26 ~ 2022-02-28 |
| Barbara B Gardner | 15a College Highway, Southampton, MA 01073 | Tax Preparer/facilitator Permit | 2020-02-19 ~ 2022-02-28 |
| David E Pinsky | 9 Buchanan Circle, Southampton, MA 01073 | Professional Engineer | 2019-02-01 ~ 2020-01-31 |
| Thomas J Hogan IIi | 6 Madeline Way, Southampton, MA 01073 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Bruce A Coombs | 33 Manhan Rd, Southampton, MA 01073 | Land Surveyor | 2020-02-01 ~ 2021-01-31 |
| Amanda C Loftus | 14 Freyer Road, Southampton, MA 01073 | Registered Nurse | 2020-02-01 ~ 2021-01-31 |
| Heather Lashway | 5 Madeline Way, Southampton, MA 01073 | Certified Public Accountant License | 2020-01-01 ~ 2020-12-31 |
| John Jude Furman | 2 Birchwood Dr, Southampton, MA 01073 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Find all Licenses in zip 01073 | |||
| City | SOUTHAMPTON |
| Zip Code | 01073 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + SOUTHAMPTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Kiersten Striebe | 37 Rowsley St, Bridgeport, CT 06605 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Physician Assistant Foundation of The American Academy of Physician Assistants | 2318 Mill Rd Ste 1300, Alexandria, VA 22314-6868 | Public Charity | 2019-12-01 ~ 2020-11-30 |
| Theresa V Horvath | Physiican Assistant Institute, Bridgeport, CT 06604 | Physician Assistant | 2018-10-01 ~ 2019-09-30 |
| Kiersten L Lopes | 62 May St, Naugatuck, CT 06770-4249 | Paramedic | 2020-03-01 ~ 2021-02-28 |
| Kiersten M Striebe | 37 Rowsley St Apt 4, Bridgeport, CT 06605-3084 | Radiographer | 2020-04-01 ~ 2021-03-31 |
| Kiersten Ashley Ursin | 1 Laurie Dr, Enfield, CT 06082-2108 | Registered Nurse | ~ |
| Kiersten N Rooney | 140 Sturbridge Ln, Monroe, CT 06468-1528 | Registered Nurse | 2020-01-01 ~ 2020-12-31 |
| Kiersten D Belanger | 5 Shepard Ln, Plainville, CT 06062-1125 | Occupational Therapist | 2019-08-01 ~ 2021-07-31 |
| Kiersten Oszmian | 53 Cindy Ln, Berlin, CT 06037-3104 | Massage Therapist | 2019-03-01 ~ 2021-02-28 |
| Kiersten Oakes | 42 S Cherry St Apt 320, Wallingford, CT 06492-3597 | Pharmacy Technician | 2020-04-01 ~ 2021-03-31 |
Please comment or provide details below to improve the information on KIERSTEN M REVORD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).